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Watch video here or here .

Now you are ready to start the exercise.

1) Exhale and gently activate your pelvic floor muscles *), feeling this activation spread to your deepest abdominal muscles as well. Raise your hands hands off the floor and balance. Keep the roll as still as you can. Try not to dig the leg into the floor, but let your trunk do the work (see above). When you can balance like this, on and off,  for 5-10 minutes, switching periodically between the right and left leg, progress with step 2, gradually working your way towards step 5. Always start as in step one, with an exhale and gentle activation of your deep stabilizing muscles through your pelvic floor.

*)pelvic floor muscle activation, sometimes referred to as “Kegels”: To identify the pelvic floor muscles, stop the flow of urine, take note of  what you are doing to make this happen. You are now contracting your pelvic floor muscles!

2)  Balance with hands across the chest.

3)  Raise your arms in the air, keeping your hands close, as in holding a ball, and make slow circles in the air.

4)  Hold one arm across the chest, keeping the arm on the side of the elevated leg straight in the air. Make a slow chopping motion to the side. 

5) Move both arms, making slow, sweeping motions parallel to the floor, on the side of the elevated leg.


Perform the exercise 1-2 times per day until muscles are tired. Be patient! Give the exercise time to take effect, and don’t try to exercise at a level you are not ready for yet, lest you end up bracing and holding your breath. Stability does not equal rigidity. Most individuals will notice that one side feels weaker and harder to control than the other. Focus on strengthening this side, to achieve greater symmetry.

​Progressing to the final step may take weeks to months, depending on where you start and how often you practice. As you’re working on this as an exercise, also try to incorporate this stabilizing strategy into your every day activities.

This supported position, with the slow movements described, gives you a chance to start learning how to control your trunk, and from here you can gradually progress to the upright position, with more dynamic and functional exercises that involve movement and replicate natural activities.



Postural habits that maintain spinal/trunk stability

​Use it or lose it  is an admonition that applies not only to cognitive skills, but to musculoskeletal ones as well. In order to maintain the thickness and good function of the precious deep muscle layer of the spine, we have to use it regularly. Spending countless hours in a chair, sofa or car seat all day, every day, allows trunk muscles to rest themselves into oblivion. Our hunter-gatherer ancestors got plenty of rest every day as well, but if modern-day tribespeople are a good proxy, their rest positions included postures that allowed muscles to stay more active.

A good rule of thumb for sedentary workers is to briefly stand up every fifteen minutes, and intersperse time reclining in office chairs with standing and sitting upright without a backrest.

​Becoming habituated to more natural movement patterns that include squatting, bending from the hips, or "hip-hinging", when picking things up instead of allowing the trunk to relax and passively fall forward, all engage stabilizing muscles and prevent atrophy and unstable movement patterns.

​Neck stability    


The muscles of the neck have a similar organization. There is a deeper layer of muscle, located very close to the vertebrae, called (somewhat unimaginatively), the Deep Neck Flexors, or DNF for short. They provide stability of the seven cervical (neck) vertebrae, and decreased activation of this layer, with increased activation of the more superficial muscles (visible under the skin) is correlated with unnatural postures and movement patterns, and with chronic neck pain. 








​








​Deep Neck Flexors: Longus captis, longus colli

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You can learn how to identify and activate this deep stabilizing  system using the exercise below.

Lie on your back with your knees bent, head resting comfortably on a pillow or a book. Locate the Sternocleidomastoid muscle  (SCM) at its insertion at the inner corner of your collar bone. You can see it clearly in the photograph below, running from just below the ear, to the inner corner of the collarbone. 

To many prospective patients Telehealth is still a new option. What follows is a list of frequently asked questions, to help you get acquainted with what awaits at the most recent frontier of healthcare, and how you can benefit now.



Why should I use Telehealth instead of being seen in a physical therapy office?


At this time, one of the benefits is more obvious than ever. Telehealth offers therapy without the need to leave your home, and the recent stay-at-home order, while not preventing physical therapy in a physical office, has made many choose the stay-at-home therapy option.
There are many other reasons for having therapy at home. Convenience, saving time, avoiding a difficult or tiring commute are reasons many patients share.



Does Telehealth have any distinct and unique benefits?


Since a Telehealth session doesn’t require you to leave your home is is a lot easier to fit a physical therapy session into your day. Telehealth brings the therapist into your home and enables her or him to make concrete suggestions for improving your work station, chairs you spend a lot of time in, your workout space etc. If a personal trainer comes into your home on a regular basis, or if you work out at home, you can use a Telehealth session to have your physical therapist review your workout in real time, and make sure it is safe and appropriate, and make suggestions for improvement. Home exercises are reviewed in the actual environment where you are performing them, as opposed to in the therapists office. It may also be easier for a loved one, or other person assisting you, to be present.

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​Use it or loose it is an admonition we hear often  when it comes maintaning lean tissue (muscle and bone). It It is probably one of the better examples of a  a cliche, but the saying does communicate an important truth: our bodies are made for activity, not passivity, and will deteriorate at a surprising rate during inactivity. This is especially true for older adults, who lose lean tissue much more rapidly than the young during periods of physical inactivity.
 Loss of muscle mass due to prolonged (which may be defined as as little as a week or two during bed rest) inactivity predominantly affects the largest muscles of the body, the muscles of  the legs and buttocks.
 Inactivity also poses a significant threat to our health in other ways, and contributes to everything from cancer to heart disease. It has been even estimated that physical inactivity causes as many deaths as smoking, hence the recent jingle “sitting is the new smoking”. 
 In the population of people 65 years of age and older, decreased levels of physical activity contribute greatly to the epidemic of falls and subsequent injuries. A third of all individuals 65 and older fall each year, and in half of these folks the falls are recurrent
 During this time, when the entire population has been encouraged to practice social distancing and work from home, and gyms have closed and everyday movement been minimized, we risk limiting our physical activity and exposure to fresh air and sunlight to levels that pose a threat to our fitness, health and safety. 

Physical inactivity also increases pain levels in patients with chronic pain. In all individuals, but especially in those with hypermobility disorders it is imperative to not allow the system of stabilizing muscles to atrophy and weaken due to inactivity, as this is a common turning point for increased pain and dysfunction.



Exercise has a multitude of amazing effects on our body and mind, and we’d do well to harness these benefits at a time    
                                          when we all need to support both our mental and physical health.



 
Movement and resistance training to the rescue
 Physical activity has an effect on almost every organ and tissue in the body. It supports immune system function, is important for mood and general wellbeing and, when performed outdoors, strongly contributes to circadian rhythm entrainment (ie our daily sleep-wake cycle). The best intervention to prevent and treat loss of lean tissue is resistance exercise, which simply means that your muscles are straining against an external force, be it a weight, an exercise band or the weight of your own body moved against gravity, when coupled with an appropriate protein intake. However, sitting all day and only moving once a day for exercise may not do the trick, either, as there is some proof that sitting 13 hours a day or more, easily accomplished, especially during social distancing, may undo all the metabolic effects of the exercise and leave you with the elevated levels of triglycerides and blood sugar that exercise normally counteracts.



                                     For those aged 65 years and older, it is also recommended that protein
                   intake be increased from 0.8g/kg/day to 1,2 g/kg/day in order to maintain lean body mass.
 


So how much activity is enough to confer beneficial effects? Is picking one activity that you like enough? Think about it this way: what we call exercise is our way of  compensating for the lack of spontaneous movement and hard work that evolution has prepared us for, and consequently expects. Therefore, engaging in only one type of movement, such as walking, is not enough in order to emerge from temporary isolation and inactivity unscathed. Instead, we need variety. All types of physical activity have distinct effects and benefits. 



 
The best intervention to prevent and treat loss of lean tissue is resistance exercise, which simply means that your
​            muscles are straining against an external force, be it a weight, an exercise band or the weight of your
                                                                       own body moved against gravity.
 



DAILY EXERCISE ROUTINE

What follows is a program that will help meet your body’s need for frequent movement through the day, movement for circulation, cardiovascular health and immune system support, and maintenance of lean body mass. It is divided into three sections, with the section for strengthening divided into two subcategories. The sections offer activities of varying  levels of difficulty and a chance for variety. Choose the most appropriate levels for you --you should be working hard but be able to maintain good form, or quality of movement,-- and make sure to pick one choice from each group. All exercises should be pain free, but mild soreness at the beginning of an exercise is fine. Follow the traffic light guidelines to distinguish between innocuous soreness and pain as a sign to stop.

Two exeptions to be aware of: perform all three stretches daily, but perform strengthening exercises only every other day if you are able to perform them at an intensity that gives you a bit of exercise soreness the following day.



 GROUP 1- Frequent movement through the day

• Briefly stand up every 15 minutes.

• Putter around often through the day. In scientific circles this is known as non-exercise movement and constitutes an important signal to the body to maintain lean tissue.

 GROUP 2 - “Aerobic exercise” or prolonged higher intensity movement
Best if performed outdoors when practical and appropriate (note that future directives for social distancing may include avoiding time outdoors, and even in the absence of such directives you should follow the advice calling for keeping a distance of at least 6 feet between yourself an others).

• Walking
• Run- walk (alternating between running and walking)
• Running
• Use of exercise equipment such as stationary bike, elliptical trainer, rowing machine
• Running or bicycling

GROUP 3- Strength training
The most important muscles to strengthen are the muscles of the buttock and legs.
 Stabilization exercises: 

• Specific stabilization exercises prescribed by your physical therapist
• Push-ups, keeping trunk stable
• Planks
• Trunk stabilization: lying on your back, keeping back stable against the floor, moving legs to add resistance

 Lower extremity strengthening (legs, hips/buttocks):

• Squats 
• Lunges

Note: the planks and push-ups also address stability and strength of the shoulder girdle and arms; the stabilization exercises, especially the stabilization exercise performed lying on your back, also address abdominal strength.

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GROUP 4 - Flexibility

• Chest stretch
• Hip flexor stretch
• Back extension, lower and mid back

Note: you can certainly stretch and mobilize many more areas of the body, but do include the above, as they are shortened on most sedentary individuals, and contribute to dysfunction in many other areas of the body. 


                                            All types of physical activity have distinct effects and benefits. 




IMAGE GALLERY FOR THE EXERCISE PROGRAM


Trunk stabilization exercises

  The single leg squat is a progression of the above lunge shown in the previous photo. Place one leg on a 
  bench, sofa or chair and lunge down, again keeping in mind that the knee must track in line with the foot, 
  not to the inside of it it! Prioritize correct form over trying to squat more deeply.



                                                                                       
Stretching or "Strelaxing" (aka a relaxed stretch) 

Succesful stretching  means relaxing muscles, not pulling them. The stretching position allows you to feel the muscle, the stretch itself consists simply of your conscious relaxation of the muscle. Think 
"melting', or imagine the body part growing heavy. Hold stretches for 2 minutes or more.​

​

​Chest stretch (specifically for the small chest                                             Mobilization of the upper back. Roll up a yoga
muscle, pectorals minor, that greatly contributes                                     mat, and place it under your upper back (you
to limited shoulder movement). Lie down as                                             can vary the exact position for bets effect). 
shown, place a pillow/pillows under your arm as                                      Bend back to straighten the convexity of your
needed. The arm must be supported.Tip hips                                              upper back as shown. This is a back and forth  
towards opposite side to increase stretch                                                  motion, not a static stretch. 
as needed.

                                                                                                                             A comfortable variation is        
                                                                                                                             simply placing a folded up towel 
                                                                                                                            under this part of your back and relaxing
                                                                                                                            with arms stretched out
                                                                                                                            and hips and knees extended,
                                                                                                                            or, if needed, bent.   
                                                                                   

Hip flexor stretching. Choose either option as illustrated above. The stretch is diffuse and felt
across your groin area. Remember to remain comfortable and relaxed. Stretching is about relaxing
muscles, not pulling or forcing. 

Those hypermobile individuals whose hips joint tend to subluxate forward should be careful not to lunge forward to far and too deeply while performing a single leg squat or walking or stationary lunge, and should keep their upper leg supported by the bed in the image above, completely avoiding hip stretch option number two.

                                 
                                                                                                   *****

​                          
Remember: there is still much to enjoy, and stressful times can also contain good times. Enjoy the things you can do, things you perhaps now have the time to do. Enjoy the time with, and exercise together with, your family members. By balancing activity with relaxation you will support both your musculoskeletal system and your emotional health

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​What impacts the immune system?


Immune system function varies over the course of life, with newborn babies depending on antibody protection through nursing, many lifestyle factors common among adults taxing the immune system and many, although not all,  people over the age of 65 experiencing some immune dysregulation that makes them less able to respond to immune challenges. This also manifests as a decreased ability to create antibodies and a resulting diminished response to vaccination in older adults.

Medications such as cortisone, other immunosuppressant medications, chronic stress, malnutrition, loneliness, overexertion, a sedentary lifestyle, overuse of alcohol and poor sleep and irregular sleep/wakefulness cycles (aka circadian rhythm dysregulation)  are some of the more common factors that can tax this powerful system and prevent it from effectively defending us from pathogens.


Can you “boost” your immune system?

The answer is generally “no”, but more importantly, you wouldn’t want to. An overactive immune system means feeling inflamed, unwell, allergic or experiencing an autoimmune reaction. What you do want, however, is to make sure your immune system functions properly.



The effects of nutrition on your immune system

Not unlike other bodily functions, the immune system is dependent on certain nutrients. While few individuals in the developed world are dying of hunger, lifespan and quality of life may for many be affected by poor nutrition. It has been estimated that 35% of those aged 50 years or older in Europe, USA and Canada have a demonstrable deficiency of one or more micronutrients . Children may suffer from vitamin and mineral deficiencies due to selective eating habits or lack of sunshine, and the elderly tend to eat less food, but still require the same amounts of micronutrients (and even more protein than younger individuals), which can make for a tricky equation to solve.



Micronutrients that are especially important for immune system function include: 

• vitamin A  -crucial to immune function throughout the body, and contributes to the maintenance of the barrier created by the epithelial lining in the respiratory and gastrointestinal tracts. (Note that beta carotene is not the same thing as vitamin A.)

 

• vitamin D - like vitamin A, it is involved in many areas of immune function, and deficiency can increase the risk of infection, especially respiratory tract infections.

 

• vitamin E - has a potent anti-oxidant effect and is also involved in immune function. Deficiency has been shown to increase risk of influenza infections in the elderly.

 

• the mineral Zinc is especially important because it maintains the activity of more than 300 enzymes, including in white blood cells, such as phagocytes and  natural killer (NK) cells. Even marginal zinc deficiency is known to result in atrophy of the thymus gland and can increase the risk of infection.

 

• B vitamins - deficiency in B6, B12 and folic acid impairs immune function and immune response.

 

• vitamin C - supplementation with vitamin C reduces the duration and severity of common cold symptoms in deficient adults. In those under physical stress (e.g., at work, during sports, and under extreme temperatures) or in cases where vitamin C levels are slightly below recommended levels, vitamin C supplementation reduces common cold incidence.

 

• Iron and Selenium

Please note, however, that healthy eating habits and supplementation can only support normal immune system function by supplying it with the building blocks it needs to function. You can not build some kind of super immunity by supplying your body with higher than physiologically necessary amounts of these nutrients, or any other interventions either, just like, while sleep deprivation can make you more susceptible to infections,  sleeping more than necessary won’t increase your resistance to infections.



Inflammaging

Inflammation and aging seem to go had in hand, leading to the concept of inflammaging, an imbalance between inflammatory and anti-inflammatory networks contributing to common age-related changes, including immunosenescence, or the aging of the immune system, which, as mentioned, contributes to the increased susceptibility of many older individuals to infectious disease. Anti-inflammatory nutritional interventions can therefore be useful. Fortunately, the  aging of the immune system is quite  malleable, and affected by both lifestyle choices and medications.

In patients with diabetes the immune system is suppressed by the elevated blood sugar levels. Metformin is a drug commonly used to counteract this phenomenon. The herbal compound Berberine has similar effects, leading to speculation that it could help non-diabetics keep blood sugar levels at ideal levels and thus support the immune system. 

Physical activity exerts an anti-inflammaging effect via several mechanisms. Studies have also shown that individuals who perform regular exercise appear to be at a reduced risk of mortality from infections. Exercise also tends to raise Human High Density Lipoprotein (HDL) levels (levels of what many like to call “good cholesterol”). HDL has both anti-inflammatory and anti-oxidative effects. 

Other ways of attenuating inflammaging include avoiding caloric excess and eating a nutritious diet. Diets like the Mediterranean diet or other personalized diets with nutritional supplementation with micronutrients and limonene have been shown to both decrease inflammation and improve immune responses.



In summary….

Anyone wishing to improve their body’s resistance to infection and illness, whether chronic or acute, can benefit from first and foremost supporting their body’s basic functions by ensuring sufficient levels of nutrients through both diet and supplementation, as well as observing other healthy habits and practices that allow the body to function optimally.

Even when a vaccine exists for a particular disease, it is the person’s own immune system that creates the antibodies, and a weak immune system is less able to do so, leading to an antibody response after vaccination of only 17–53% among the elderly.

Regular sleep/wake cycles supported primarily by appropriate exposure to light and darkness, supporting sleep, which I’ve written about here, movement, spending time in nature and avoiding loneliness and stress are all powerful tools. Older individuals need to be especially mindful of taking good care of their immune systems, and this includes taking steps to reduce inflammaging. Exercise regularly, move often, give yourself reasons to laugh even more often, eat well and supplement wisely.

Did I forget anything? Comment with suggestions here!

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The stuff that balance is made of


Mechanoreceptors are tiny, specialized sensory receptors that are located within joints, muscles (muscle spindles), ligaments (Golgi tendon organs), joint capsules and tendons. They communicate information about pressure and tissue lengthening to the central nervous system (the brain and the spinal cord), creating proprioception. The deep layers of the skin and the fascia, (the connective tissue layer that covers our muscles and organs and tie the body together as if though through a three-dimensional fishnet), also act as supplemental sources of information for our sense of proprioception. This system helps us both stand, walk and move while our conscious attention is focused on something else, and create precise movement at will. It helps us use just the right amount of muscle tension, and use our joints in a manner that is precise enough to not overload support structures such as ligaments. It helps us balance our tall bodies against the downward pull of gravity, and balance our head on our neck without unnecessary muscle tension and ligament strain.



Balance is an important skill, and most commonly needed in the form of what physical therapists like to call single limb standing, ie standing on one leg. Whether you would like to walk, run, step over or into something, be it a bathtub or a pair of pants, you need to be able to balance your body on one leg. The ability to do so is a skill, and skills are composed of many components. You need the raw muscle strength of muscles such as the gluteus medius, a (as the name implies) medium-sized buttock muscle that helps keep the leg straight underneath you. You need proprioception, the understanding of what is going on based on all that information flowing to your brain and spinal cord from the mechanoreceptors throughout the body, and you need the ability to pull all that together into a movement program, created in the motor cortex in you brain. The motor cortex is where the software for our movements, or motor programs, are stored, and this software is constantly either being improved or deteriorating, depending on how much and how well you use it.




When the system fails


That is all fine and good, the uncoordinated and poorly balanced among us may say. Amazing as this system may be, I am still having trouble with my balance and my coordination, so what gives?


This is a question with many potential answers, so let’s go through them one by one.


In certain individuals one reason proprioception, and therefore balance and coordination, may be decreased, is joint hypermobility. Joint hypermobility is usually caused by a congenitally softer type of connective tissue, making joint capsules, ligaments, and tendons less resistant to stretching. A recent paper estimated the prevalence of generalized joint hypermobility in a university-aged population as 12.5%, while a more severe form of hypermobility called Ehlers-Danlos may affect as many as 1 in 5,000. Stretchier tissues will lengthen father than stiffer ones before they are triggered to signal about lengthening, and this may contribute to the decreased proprioception in hypermobile individuals. 


An injury, such as an ankle sprain or ACL tear, may cause hypermobility or laxity in a single joint, causing the proprioceptive input from the injured joint to decrease, leading to instability in this but not other joints.


Aging tends to decrease the input from the periphery, due to deterioration of mechanoreceptors, and perhaps in part due to age-related stiffening of connective tissue, and may also change how the brain processes incoming data. Older people tend to be much less physically active than younger people, and, especially in industrialized societies, loose joint flexibility and range of motion, causing poor communication about joint position for reasons opposite of that of the hypermobile.


Inactivity decreases muscle strength, but in terms of balance and stability the effect of inactivity may be even more deleterious on the levels of the “software” of the brain, resulting in a decrease in the number of brain cells dedicated to propriocetive analysis and the previously mentioned motor programs.




Short- and long term dangers of poor proprioception


With laxity, injuries, inactivity and aging comes a different strategy for using the body. Instead of controlling joint movements in a skilled, precise way, we start to utilize stiffening strategies, which is like moving from the smooth, controlled movements of a jumping cat to the stiffer, wobbling of a duck. This stiffening, which means we are tightening muscles as if though walking on thin, slippery ice, is neither good for muscles, which start to ache and complain under the constant burden, nor is it healthy for our joints, which are not properly protected by these inferior strategies.


With decreased proprioceptive prowess, decreased muscle strength, less effective stabilizing strategies and less impressive brain software comes an increased risk of acute falls and injuries, which can be devastating and present an enormous problem among the elderly. A decreased sense of joint position and movement can also lead to less stability of and a less precise use of joints. This, in turn,  can lead to microtraumas, tiny but cumulative injuries, that wear out cartilage and keep muscles and ligaments in a perpetually irritated state, ligaments because of the painful pulling on them and muscles due to the resulting chronic, compensatory stiffness.



Fear not, there is great news!


So are the stretchy, the injured, and the aging among us doomed, (not to speak of those that are stretchy, injured and growing older)? As always, exercise to the rescue!


With continued activity and exercise that challenges and strengthens our body we can all improve, sometimes tremendously so. Due to the incredible plasticity of our body, or the ability to continuously change in order to adapt to the demands placed upon it, we can all compensate for imperfection in one organ by improving another. The initial instability caused by a torn ligament, such as the ACL or MCL ligaments of the knee, can, through therapeutic exercise, be compensated for by increasing reliance on inputs from other tissues.


The incredible muscle control of a classical dancer, who typically is quite hypermobile, is a beautiful demonstration of this ability to adapt and compensate trough continuous training and effort. The negative effects of aging are as much a correlation with increasing levels of inactivity as they are a result of inevitable aging-related changes in tissue. Regular physical exercise maintains the joint position sense, or the proprioceptive ability to feel our joints, of older individuals at near that of non-exercised younger individuals and more than twice as good as that of sedentary older individuals. As a matter of fact, the only strategy that seems to retain or help regain joint proprioception in older individuals is regular physical exercise.

  
Pain exists for a reason. It is a warning sign that helps us protect our tissues. So shouldn’t we always heed the warning, and do everything in out power to avoid pain? 
​

The short answer is no, and this post is the longer, more detailed answer to that question, because pain is too important a phenomenon to misunderstand. Completely disregarding pain signals can lead to inappropriate movement patterns and habits, and subsequently to gradual, or even sudden, tissue breakdown. But being too avoidant of pain can lead to tissue weakness, deconditioning and decreased function. It can even shorten our lives. Sounds like a bit of a dilemma, doesn’t it?  But it need not be, so let’s take a closer look.


We have evolved for a lifestyle where pain co-exists with other drivers such as hunger or the need for social belonging and safety. If our prehistoric ancestors hurt their knee or their back a bit, they still had to keep moving in order to forage and hunt. The pain simply meant “move with awareness, maybe a bit slower or differently”. It did not mean “Stop!” Only the excruciating pain of a broken bone would have categorically stopped hunter-gatherers in their tracks. This balancing act helped them recover without weakness.


Today we have high-tech imagery that shows what we are told is damage to our tissues, experts that give us ominous-sounding diagnoses for our ailments, and the ability to put dinner on the table without being physically active. This has gradually lead to a different interpretation of pain. Now virtually all pain seems to mean “stop”. This leads to lifestyle where we carefully avoid feeling more of it by moving less. Unfortunately, relating to pain in this manner can actually lead to the very thing we are trying to protect ourselves from, more pain and decreased function.


                  Taking steps to avoid pain can sometimes lead to more, and chronic pain.


But just like we use our intellect, instead of our hunger, to tell us when we should get some exercise these days, we can figure out when to move and when to stop even though circumstances don’t dictate the rules anymore. In order to do that we need to take a closer look at the various types of pain and what they mean.


Pain can be divided into four types: nociceptive, peripheral neurogenic, central neurogenic and central sensitization. Peripheral neurogenic is nerve pain like the kind stemming from a pinched nerve. Central neurogenic pain stems from damage to the brain from an insult like a stroke, and central sensitization is an exaggeration of the type and intensity of a painful, and even non-painful, signal that can occur with chronic pain. I’ve written about that here. But most of the time what we’re feeling is musculoskeletal pain, ie the nociceptive type. This is pain stemming from tissue injury such as the pain that may occur after exercise or stubbing a toe, inflammation, pain from cramping,  or other phenomena that lead to pain due to hypoxia, or insufficient oxygen in the tissue. 

​
Below is a chart where the various types of pain are organized according to my “traffic light system” that can help you decide how to related to a pain you’re feeling and know whether you should move or avoid movement. 



TRAFFIC LIGHT SYSTEM OF PAIN

​Red- severe, sharp pain that takes your breath away - Stop doing what you’re doing.
Yellow- Some discomfort that doesn’t seem to get worse with what you’re doing -
Keep moving, with awareness.
Green- movement feels great, or is gradually decreasing the discomfort - Keep right on moving cap’n!


Here are some examples of conditions where you might judge the pain you feel as either a green, yellow or red light:

Green                                               Yellow                                                            Red
Muscle soreness from exercise,  Soreness and pain in tissues such as         A broken or se-
stiff muscles, arthritic joints,        ligaments and tendons that have               very weakened 
                                                          been overloaded and hurt (tendonitis,       bone or other 
                                                          plantar fasciosis etc), intense muscle         conditions where
                                                          cramps and spasm, healing tissues            you’ve been told to
                                                                                                                                    absolutely                                                                                                                                                                                                   
                                                         Central sensitization                                       avoid loading
                                                         Central neurogenic pain                                the tissue for a
                                                                                                                                    while, recent surgery            
                                                                                                                             
                            
As you can see, pain should rarely be interpreted as an absolute ‘stop’. 

But, why not err on the side of caution and avoid the discomfort caused by movement when soreness or pain is present? Why, I thought you’d never ask! 

The reason we should always move if we can (no red light present) is that our bodies unequivocally need movement. That’s how they are designed. Movement adds forces to our tissues, signaling the need to build them stronger. Movement increases blood circulation, bringing oxygen and building blocks to tissues, helping them grow stronger and repair themselves after use or injury. Movement keeps our nervous system healthy and maintains our ability to feel, coordinate movement and balance. Any time we have to, or choose to, avoid movement, we are choosing not to have these phenomena benefit us, and unfortunately this causes our tissues gradually atrophy, or grow weaker. This makes us not just less able and strong, but also makes us more vulnerable and more at risk for injuries. 


                                          Exercise also decreases pain by activating brain
                                       pathways that block pain signals, so suffering from
                                       pain should actually be a motivator for movement,
                                                          not movement avoidance.


Speaking of injuries, some of us don’t choose the too careful, pain-pain-avoidant path.  They stubbornly keep charging ahead, and see pain as something of a personal offense, and pushing through the pain as a badge of honor. (You know who you are!) Remember the yellow light that means ‘move with awareness’? That also means intelligently changing the load on your tissues as needed, even as you keep moving. A runner whose hamstrings are hurting, and don’t get better with continued running, should of course address the reason for the pain, and during this process s/he will most likely benefit from some modification of their sport; running less or less often. Here the ‘awareness’ leads to change, being aware of what it is that is causing the pain and addressing the issue. (Hint: that most likely means a consultation with a physical therapist. These things can sometimes be hard to figure out on your own.)


And speaking of yellow lights, there are many circumstances that should alert us to the need to ‘move with awareness’ and very gradually give out bodies the chance to grow stronger. If you are increasing your activity level, whether you are a seasoned runner who wants to increase your mileage or are starting an exercise routine for the very first time, give your tissues time to gradually get stronger. Connective tissue, which makes up most of what we are: bones, ligaments, tendons, skin etc, grows stronger much slower than muscles do. Don’t run ahead, literally or figuratively , and only follow the lead of your muscle strength. People with hypermobile joints, approximately 5-15% of the population, should also “start low and go slow” and give their weaker connective tissue a fair chance to grow stronger. If you are recovering from an injury, you are also rebuilding your tissues, so increase activity at an appropriate pace.


So, when in doubt, move. Consult the traffic light system, decide whether yours is a green, yellow or red light, and keep moving. Get some movement every day, and more intense movement at least three times a week, and enjoy growing stronger!