The Critical Factors You Need to Be Considering
Our nervous system searches for familiarity. This is helpful in the short term by allowing the nervous system to make quick predictions about how to best respond to incoming information. The way we like to think of it, is that when we receive information from our environment, our nervous systems goes into its filing cabinet of sensorimotor experiences to ask “when has this happened before.” This filing cabinet stores all of our past experiences and shapes all of our movement and behavior. This is quick and effective, because it allows us to predict what might happen or what kind of movement we need to express to stay adaptable. This concept is important because as we move through the real world, our nervous system is constantly being bombarded with lots of input, and so it can’t possibly process all of this information accurately.
Now, we’ve all got different content in our filing cabinets, full of different past experiences that shape our beliefs about movement and behavior. As rehab and movement therapists, we tend to think that when it comes to movement, that it’s all the information from our muscles and joints. But our movement is a reflection of how the nervous systems process and weighs these multiple streams of information against what’s already in our filing cabinet. Our vestibular system, our visual system, our cerebellum, our PAST EXPERIENCES, our BELIEFS, and much more, all have a huge influence on how our movement is expressed. This multi-layered input is very important to consider when it comes to pain.
What is important to understand here, is that anything that threatens our system will be registered by more than one sense. For example, if I’m performing a particular movement and I hurt my back for the first time, that experience will be registered by more than one sense. This has many survival benefits, because registering that experience by more than one sense will allow me to make faster predictions about what I need to do if I’m ever in a similar situation in order to stay safe. This multi-sensory experience is sometimes referred to as a “neurotag.” To keep it simple for this newsletter, think of a neurotag as a snapshot of all the sensorimotor components experienced at a given time. If I hurt my back during a deadlift, it’s not just the position of my muscles and joints that are registered, but the environment I’m in gathered from my eyes, the sounds, the input from my vestibular system, and of course the pain/protection that is expressed at that time. This neurotag keeps us further protected, because if I go back into the same environment a few weeks later, my nervous system will know that the last time I was here, I hurt my back. It doesn’t mean you’re going to express pain, but it may increase the sensitivity of the feedback from particular body parts. This is the predictive brain in action.
Let’s say that you went to see your doctor about your pain, and he/she said that you have damaged your spine. How do you think this will influence the content of your filing cabinet? How do you think it will influence the movement of your spine? Those words have now potentially become tagged with the other components of the neurotag, and future movement of the spine will be weighed against those words. We appreciate that the experience of pain is MUCH more complex than this, but our goal is to offer an insight into the importance of reorganizing as much of our clients’ filing cabinet as we can, while staying within our scope of practice. The beliefs and past experiences that an individual possesses is critical for us to understand and slowly re-shape in order to restore robust movement qualities. In the attached study, we can clearly see how an individual’s beliefs have greater potential to predict outcomes versus what their structure reveals. In the study they found that those with lower expectations of a full recovery and lower pain self-efficacy had worse outcomes. We are more than just muscles and joints. Our movement and behaviour is a reflection of how our many sub-systems interact with each other, and the more layers of an individual’s experience we can influence in a positive way, the greater the change we can facilitate.
When it comes to our examination of a client, considering more layers than just the physical layer is incredibly important. LISTEN to how they describe their pain experience and get an insight into their expectations for a full recovery. Their response will reflect the amount of importance we place as therapists on trying to re-frame their beliefs and allow them create a positive outlook on recovery. Instead of thinking what stretch or what “pre-activation” movement we need to do to progress their load tolerance, why don’t we facilitate a more positive environment before we engage with movement? Let’s use our words to mobilize the nervous system instead of movement only. Disrupt the negative components of their neurotag and replace with sensorimotor components that encourage resourcefulness and resilience.