Saturday, 5 December 2015

Spa or Bootcamp: A Case For Considering the Nervous System in Pain management

Once upon a time there were two ladies who had fallen and ended up with a neck injury. Both had visited the ER and were sent home with a brace. One of the ladies was super relaxed about the whole thing and was somehow okay with what had happened. The other one was still in a bit of shock about the fall and completely wound up. Even just a gentle touch made her jump and scream like she had been hit. 

What was the difference between these two individuals? Mainly it was the state of their nervous systems. One had processed the fall, her injury, and was ready to get better. (How she did that so fast is amazing!) The other lady’s nervous system was still on guard, ready to pounce on anything that might be a threat. 

So the question today is: How effective is therapy when the nervous system is so wound up? It’s pretty hard to do effective therapy if you can’t even touch the person!

One popular pain center described their program as a balance between a spa and a boot camp. You mostly saw the boot camp part in the gym; they would encourage people to push harder, keep going when they were tired, etc.  And yes, their clients did see improvement...muscles were strengthened or stretched, there were increases in people’s endurance and the amount they could lift. Progress on charts. But looking at that program we just wondered, how much more progress could have been made if they emphasized the spa part too. If they took the time to lower people's nervous system response, and didn’t add to it by the “bootcamp” approach. What would have happened?

Our guess is that they would have seen longer term, sustainable changes. From what we’ve seen, pain and all that comes with it throws a huge amount of stress on our systems. Calming the nervous system down (so that it is not constantly on edge), opens the door for you to really benefit from any other therapy. This gives you a chance to integrate it, learn from it and move towards healing. 

So, how can we do this? Well, there are many ways therapists can help to bring the nervous system back to a more balanced state. Here are just a few ideas:
  • Calm the nervous system through “relaxation” methods: visualization, acupuncture,  breathing exercises, yoga, laughter, massage, etc
  • Create a relationship of trust with your client and validate their experiences. They don’t have to “prove” their pain, it’s just accepted.
  • Reduce disability. Enabling your clients to do the things the need to do (teaching them a different way, changing the situation, etc) reduces the impact of the pain on their lives and in turn reduces the stress it places on their body.
  • Address client's fears. Listen, educate, and try to come up with a solution. There are about a zillion new worries that come with pain and even acknowledging them can take some of the pressure off the body.
  • Give your clients permission to rest. Often people in pain feel the need to keep pushing, which again adds more stress to the body.

If you’re a therapist we would love to hear what you do with your clients. What do you find works, and what doesn’t? If you have pain, what has worked for you? What are your thoughts? 

You might have noticed on this blog we talk a lot about the nervous system. Well, this is why. We believe the process of  learning to live well with pain can be only be enhanced by calming the nervous system. 

It’s kind of funny that this little post about the “spa vs bootcamp” concept has been hanging out with our draft posts since the beginning. It asked a lot of questions, provided some speculation based on experience, but didn’t provide a lot of answers as to why the boot-camp approach wasn't enough. And then we went to a course that talked all about pain and the nervous system. Lightbulbs went off! In the new year we’ll carry on this discussion and talk a bit more about how the nervous system relates to pain and why it is so important to acknowledge this connection.

Weightlifter silhouette from

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