Tag: Physical Therapy

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Cleveland Clinic: The connection between pain and your brain:

cleveland chronic back pain

Chronic Back Pain? You May Find Relief With Behavioral Medicine

Understanding the brain’s relationship to pain

No pain, no gain? Not true for people suffering from chronic back pain. Instead, it’s the opposite: Back pain is one of the main causes of missed work (and missed paychecks).

But could the key to coping with chronic back pain be in your mind? “We actually know that pain is not just a sensory, or physical, experience,” says psychologist Sara Davin, PsyD, MPH. “It is also an emotional experience.”

Dr. Davin explains how you can harness your pain management super-powers by understanding the very real connection between pain and your thoughts.

The 411 on the mind-back pain connection

To understand how it all works, think of pain’s purpose. Pain is your brain’s way of alerting you that something is wrong, whether it’s a stubbed toe or a slipped disk.

How your brain processes an injury, then shares that information, has a direct connection to the level of pain you feel. You’re aware of pain because your brain tells you it’s there. (Psst — your brain also controls your thoughts and emotions.)

“Pain is processed in the brain and the central nervous system. Both have areas connected to the sensory experience, but both also have areas connected to the emotional experience,” Dr. Davin explains. “The sensory and emotional go together to create the output of one’s experience of pain. So to comprehensively treat chronic back pain, we have to look at both sides.”

And while traditional treatments like medications and physical therapy can take the edge off, they often ignore the elephant in the room: your thoughts.

“Managing back pain with behavioral medicine strategies might even prevent the pain from becoming chronic,” Dr. Davin states.

What is cognitive behavioral therapy for pain?

CBT for pain is talk therapy’s more specialized cousin. It’s a behavioral medicine strategy that teaches people how to:

  • Make the connection between how they think about their pain and the way they interpret it.
  • Understand how pain impacts their emotions.
  • Choose coping skills to help with how they function and behave.

Still not sold? Dr. Davin gives this example: Someone who feels that their pain is unbearable may cope by lying in bed and isolating themselves from activities they value. “This cycle can go on and on,” she explains. “The person becomes more helpless and then, from a physical standpoint, becomes weaker. Naturally, they now have even more pain.”

With CBT, that helpless feeling (and associated pain) is kicked to the curb because pain psychologists teach people how to:

  • Pace activities so they don’t overdo it.
  • Practice relaxation and meditation to decrease pain and stress.
  • Soothe their central nervous system, which increases the feeling of pain when under stress.

The proof is in the pudding. Dr. Davin runs an interdisciplinary program that uses physical therapy and CBT to treat chronic back pain. Patients participate in this program for 4 to 10 weeks, depending upon their progress.

“Folks in the program were better when compared to physical therapy alone,” she reports. “We have consistently seen significant improvements across all quality of life measures, including how much pain interferes with someone’s life, levels of fatigue, anxiety and depression, plus improvements in pain-related disability.”

Interestingly, one of the metrics that improves the most in the program is how satisfied participants are in their social roles. “In our program we teach people how to start having fun again and connected with others,” Dr. Davin notes. “I suspect this is why we see people wanting to be more socially active after the program.”

3 ways to put this new knowledge into action

Here’s how you can incorporate behavioral medicine strategies into your back pain management:

  1. Find a good pain management doctor. “You want a doctor who helps you rehabilitate and regain quality of life, but who also thinks about pain beyond its physical components,” Dr. Davin says. “Patients often struggle with the behavioral piece and think it means that their pain isn’t real. But your pain is real — you just need someone to help you manage it better using behavioral medicine skills and strategies. Pain psychologists are trained to do this.”
  2. Get your research on. Dr. Davin suggests powering up your e-reader and searching for books that outline the basic strategies for cognitive behavioral therapy for pain. Your doctor may also recommend an online course or resources that offer science-based education about how to overcome chronic pain.
  3. Don’t neglect physical therapy. Dr. Davin emphasizes that physical therapy is essential to maximizing back pain relief. “A physical therapist who’s trained in pain and neuroscience education can explain why behavioral medicine treatments work, plus help you use them,” she says.

https://health.clevelandclinic.org/chronic-back-pain-you-may-find-relief-with-behavioral-medicine/

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From beginner’s yoga to more advanced practices, downward dog is one of the most popular poses…with a few common misconceptions. Physical therapist Dawn Lorring, PT, MPT @ClevelandClinic

Take a ‘Paws’ With Downward Dog

This transitional and restorative yoga pose provides a full-body stretch

Physical therapist Dawn Lorring, PT, MPT, walks through the steps of how to do downward dog correctly and shares its many benefits.

From beginner’s yoga to more advanced practices, downward dog is one of the most popular poses…with a few common misconceptions.

Rounding your back, placing your feet too far apart or putting too much weight into your wrists can all create a deeper stretch than intended — which increases your risk of injury.

Physical therapist Dawn Lorring, PT, MPT, walks through the steps of how to do downward dog correctly and shares its many benefits.

What is downward dog?

Downward dog (also known as downward facing dog, facing dog pose or Adho Mukha Svanasana in Sanskrit) is a foundational yoga pose. It’s often used as a transition between movements, like sun salutations. It’s also a form of active resting, active stretching and strengthening. This allows you to check in with yourself and re-evaluate your intentions during your practice.

You do downward facing dog by putting your body into an inverted V-shape (or pyramid), as if there were a straight line that runs through the top of your head up your spine and out of your butt toward the ceiling.

How to properly do downward facing dog

Facing dog pose won’t usually be your first movement when doing yoga. Before trying it, it’s best to loosen up your muscles and joints and find ways to work it into your overall yoga practice.

Once you’re warmed up and ready to go, follow these steps:

  1. Start on all fours with your hands shoulder-width apart and your knees in line directly behind your hips.
  2. Spreading your fingers wide, press down into your hands and tuck your toes (almost like you’re using them to grip the floor beneath you).
  3. As you exhale, bring your hips up and back, as if there’s a string pulling your butt toward the ceiling, so your body creates an inverted V-shape (or pyramid).
  4. Focus on straightening your back, not rounding it, so your head and neck are relaxed between your upper arms. It helps to focus on pressing through your arms to “push” the ground away from you and keep your arms active.
  5. Engage your core muscles and pull your tummy in.
  6. Keep your legs straight and, if it’s comfortable for you to do so, try to drop your heels down to the floor.
  7. Adjust your posture by shifting your weight between your hands and feet until you sink comfortably into the position.
  8. Hold this pose for 10 to 15 seconds at a time, making sure to breathe throughout.
  9. For a more relaxed stretch, bend your knees a little and readjust your posture as needed.
  10. When you’re done, exhale and move into your next pose or slowly lower yourself to the floor to enter child’s pose.

“Downward facing dog isn’t about keeping your heels on the ground or holding it for long periods of time,” clarifies Lorring. “It’s really about making sure you’re going to a place that’s comfortable for you, so you can adjust your body as often as you need in this pose.”

Facing dog pose variations

If you have a hard time getting down on your hands and knees, try this wall variation:

  1. Face the wall and place both your hands out in front of you so your palms are flat and your fingers are stretched out.
  2. Keeping your head and back straight and your hands on the wall in front of you, slowly walk your legs backward.
  3. As you move, walk your hands down the wall so you hinge at your hips and look directly at the floor.
  4. Keeping your head and neck relaxed, hold this pose for 10 to 15 seconds before slowly returning to stand.
  5. If you feel stress or discomfort in your wrists, you can modify by rolling up a towel or the edge of your yoga mat and placing the roll under the heels of your hands. This will decrease some of that pressure.

For a more challenging stretch that deeply engages your hips and hamstrings:

  1. While in the downward facing dog position, lift one leg up and stretch it toward the ceiling.
  2. For a deeper stretch, bend your outstretched leg back and over your body, so your knee is facing away from you.
  3. Repeat this process with the other leg, holding the pose for as long as you feel comfortable on either side.

Downward dog benefits

Downward facing dog provides a full body stretch, while also strengthening and working your:

Adho Mukha Svanasana helps improve your flexibility and control, and provides you a moment of active rest. It also increases blood flow to your head and upper body when you’re in the inverted V position. But because of this, you should talk to your yoga instructor, athletic trainer or healthcare provider before starting this position if you have:

“Facing dog pose tries to improve flexibility but also builds the strength to control that flexibility,” says Lorring. “If you’re feeling excessive stress to a certain part of your body, then you’re probably holding the pose for too long or you’re trying to go into a range that you’re not ready for. We can help you get there.”

Posted on

From beginner’s yoga to more advanced practices, downward dog is one of the most popular poses…with a few common misconceptions. Physical therapist Dawn Lorring, PT, MPT @ClevelandClinic

Take a ‘Paws’ With Downward Dog

This transitional and restorative yoga pose provides a full-body stretch

Physical therapist Dawn Lorring, PT, MPT, walks through the steps of how to do downward dog correctly and shares its many benefits.

From beginner’s yoga to more advanced practices, downward dog is one of the most popular poses…with a few common misconceptions.

Rounding your back, placing your feet too far apart or putting too much weight into your wrists can all create a deeper stretch than intended — which increases your risk of injury.

Physical therapist Dawn Lorring, PT, MPT, walks through the steps of how to do downward dog correctly and shares its many benefits.

What is downward dog?

Downward dog (also known as downward facing dog, facing dog pose or Adho Mukha Svanasana in Sanskrit) is a foundational yoga pose. It’s often used as a transition between movements, like sun salutations. It’s also a form of active resting, active stretching and strengthening. This allows you to check in with yourself and re-evaluate your intentions during your practice.

You do downward facing dog by putting your body into an inverted V-shape (or pyramid), as if there were a straight line that runs through the top of your head up your spine and out of your butt toward the ceiling.

How to properly do downward facing dog

Facing dog pose won’t usually be your first movement when doing yoga. Before trying it, it’s best to loosen up your muscles and joints and find ways to work it into your overall yoga practice.

Once you’re warmed up and ready to go, follow these steps:

  1. Start on all fours with your hands shoulder-width apart and your knees in line directly behind your hips.
  2. Spreading your fingers wide, press down into your hands and tuck your toes (almost like you’re using them to grip the floor beneath you).
  3. As you exhale, bring your hips up and back, as if there’s a string pulling your butt toward the ceiling, so your body creates an inverted V-shape (or pyramid).
  4. Focus on straightening your back, not rounding it, so your head and neck are relaxed between your upper arms. It helps to focus on pressing through your arms to “push” the ground away from you and keep your arms active.
  5. Engage your core muscles and pull your tummy in.
  6. Keep your legs straight and, if it’s comfortable for you to do so, try to drop your heels down to the floor.
  7. Adjust your posture by shifting your weight between your hands and feet until you sink comfortably into the position.
  8. Hold this pose for 10 to 15 seconds at a time, making sure to breathe throughout.
  9. For a more relaxed stretch, bend your knees a little and readjust your posture as needed.
  10. When you’re done, exhale and move into your next pose or slowly lower yourself to the floor to enter child’s pose.

“Downward facing dog isn’t about keeping your heels on the ground or holding it for long periods of time,” clarifies Lorring. “It’s really about making sure you’re going to a place that’s comfortable for you, so you can adjust your body as often as you need in this pose.”

Facing dog pose variations

If you have a hard time getting down on your hands and knees, try this wall variation:

  1. Face the wall and place both your hands out in front of you so your palms are flat and your fingers are stretched out.
  2. Keeping your head and back straight and your hands on the wall in front of you, slowly walk your legs backward.
  3. As you move, walk your hands down the wall so you hinge at your hips and look directly at the floor.
  4. Keeping your head and neck relaxed, hold this pose for 10 to 15 seconds before slowly returning to stand.
  5. If you feel stress or discomfort in your wrists, you can modify by rolling up a towel or the edge of your yoga mat and placing the roll under the heels of your hands. This will decrease some of that pressure.

For a more challenging stretch that deeply engages your hips and hamstrings:

  1. While in the downward facing dog position, lift one leg up and stretch it toward the ceiling.
  2. For a deeper stretch, bend your outstretched leg back and over your body, so your knee is facing away from you.
  3. Repeat this process with the other leg, holding the pose for as long as you feel comfortable on either side.

Downward dog benefits

Downward facing dog provides a full body stretch, while also strengthening and working your:

Adho Mukha Svanasana helps improve your flexibility and control, and provides you a moment of active rest. It also increases blood flow to your head and upper body when you’re in the inverted V position. But because of this, you should talk to your yoga instructor, athletic trainer or healthcare provider before starting this position if you have:

“Facing dog pose tries to improve flexibility but also builds the strength to control that flexibility,” says Lorring. “If you’re feeling excessive stress to a certain part of your body, then you’re probably holding the pose for too long or you’re trying to go into a range that you’re not ready for. We can help you get there.”

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Oneday there will be a gym in my practice with physical therapists and I will be prescribing exercise.@DrBrianHiggins

harvard strength trainingDr Nina Byrnes and Angela O’Donoghue liked

18 hours ago

One of my favourite things is to do some exercises with patients. Basic stuff for knee or shoulder pain but it is so rewarding to have something to offer other than tablets. Someday there will be a gym in my practice with physical therapists and I will be prescribing exercise.