3 key points
1. Nothing happens in isolation.
2. We are designed to change, grow and develop.
3. Nothing is permanent.
Bearing these fundamental points in mind, we seek to create and then cultivate the right conditions so that we may move forward in life. In terms of rehabilitation, we also look to create the conditions to achieve wellness that manifests in an ability to perform at home, at work and on the field of play.
Nothing happens in isolation: we are on a continuous pathway with an underpinning genetic make up that is sculpted by our experiences and environment (epigenetics). So when we experience a pain or an injury, the immediate physiological and behavioural responses that so affect the pain perception, will be determined by what we know and by what our brain knows (we do not know all the things that our brain knows. Or our nose knows). When designing and implementing a training programme for a painful condition, this is an important principle as the patient will have a story leading to the point when they exercise that will determine the response including what they have done physically, how they are feeling and what they are thinking. Anticipation and expectation must be addressed.
We are designed to change: neuroplasticity is a feature of the neuroimmune system that allows us to learn and change. However, the mindset around this is key. We must understand the we can change and have a belief that it is possible in order to behave in a way that will promote forward movement in life. This must be addressed in any rehabilitation programme and indeed it may be that thinking needs to be ‘rehabilitated’ as well.
Nothing is permanent: the concept of impermanence comes from Buddhism. Nothing is permanent, even pain and other symptoms. They change as does our thinking, emotional state and body sense. We may not think it does and particularly in suffering on-going pain. However, the intensity, quality, location and nature of pain changes regularly and this is because the neuroimmune system is dynamic, ever-responding to the internal and external environments. This is why the context of the situation is so key in pain. We must think about this in rehabilitation: the context of the training.
In summary, the natural processes within the body are simply designed for us. To maximise their potential we must create the right conditions for these processes to act and this means considering the physical, cognitive and emotional dimensions of the pain experience and how they interact. A single leg squat is a single leg squat, but what is the person thinking about the single leg squat, have they done it before, will the brain consider it to be safe, where are they doing it, when are they doing it……..the list of considerations goes on. Lets consider them.