Most of the clients I treat visits the clinic because they are in pain. Obviously…

Neck pain, low back pain, pain in the shoulder etc…

Most of them come with minor problems (no neurological signs, no red flags etc…) and tons of yellow flags.

One of the most common phrases to describe their situation  is  “I feel tension here….”

They wants me to stretch that area, to massage it, to rub it, to pull it, to click it etc…

They consider their body like a machine: when a part of it is not working anymore you fix it or you replace it in order to restore the functionality.

Regrettably, how I said in the previous posts it doesn’t work in this way. If you want to reduce the risk to have these problems , one of the things you have to improve is  the awareness of your body.

Lot of people spend 8 hours in the office every day and 1h in the car or in the underground commuting to work. They come back home in the evening and the only physical activity they do is to lift up the fork to take food to the mouth sitting on the couch.

Day after day they lose  awareness of their body. With body-awareness I mean especially the capacity to understand if you are using more muscles of what that specific activity you are doing requires. The sense of the physiological condition of the entire body (interoception, Craig 2002,2003)

The ability to feel if you have unnecessary tensions in your body.

Diers et al. (2016) wrote a nice article “Watching your pain site reduces pain intensity in chronic back pain patients”

in which he shows that ” real time video visual feed-back from the painful site reduces habitual pain intensity”.

The author continues saying that: ” the awareness of one’s own body seems to be essential in pain reduction through visual input. This could be due to a shift from affective-cognitive-evaluative aspects to a sensory-perceptual processing mode.”

“The effective link between pain reduction and visual feedback from the site of chronic pain reported here is evidence in favour of an important role of visual-somatosensory integration in pain perception. The present results suggest that repeated simple realtime video feedback, without any additional manipulation, may turn out to be helpful in alleviating chronic pain.”

Thanks to my friend Tiziano for the article

https://www.ncbi.nlm.nih.gov/pubmed/26282334

Daffada et al. (2015) in: ” The impact of cortical remapping interventions on pain and disability in chronic low back pain: a systematic review.” shows that: “visualisation of lumbar movement may significantly improve movement-related pain severity and duration. A combined sensorimotor retraining approach has been shown to produce short-term improvements in both pain and disability outcomes in chronic low back pain”

https://www.ncbi.nlm.nih.gov/pubmed/25442672

Stretching or pulling a muscle without teaching your client how to feel it could be useless .

How can you decrease the tension on the upper back of your patients if they are not aware of it? if they are not aware of the fact that they are lifting up the shoulders tensing up all the muscles…

The first thing you have to work on, especially with people suffering of chronic pain, is body awareness.

How can they do an exercise properly if they are not able to feel their body? how can that exercise improve anything if they are not able to feel the movement?

It takes times and effort. People usually come for 4-5 sessions of 30 minutes each and you don’t have the time to work successfully on all of these aspects

How can you do to improve body awareness?

During the session I make them feel what having relaxed shoulders and arms means. Then I ask them to try to reproduce that sensation during the day. They have to focus often during the day on their body trying to feel if they are tensing up their muscles. I told them that I don’t want it to become an obsession but has to be done frequently at the beginning.

It is difficult to relax your body when you are experiencing pain; the first reaction is to tense it up even more.

The goal is basically to make your client feeling the body relaxed and deprived of unnecessary tension. Once he/she becomes aware of that sensation you ask him/her to reproduce it.

There are cases in which it is very hard and almost impossible to do it. These are the cases in which you need to “force the door” instead of knocking at it asking the permission to enter.

This is a perfect example of how hypnosis would be beneficial.

Look at this video of my colleague and friend Giancarlo Russo (a physiotherapist who teaches hypnosis to medical professionals in all over the world). Look at the effect that the hypnotic induction has on her muscles tone…Don’t focus on anything else but on the tone of her muscles.

https://www.youtube.com/watch?v=5pKv4YYPVFE

Da notare l’influenza dell’induzione sul tono muscolare.

Hypnosis is a powerful “technique” to improve the perception your clients have of their body.

You basically hypnotize the person and once you get the relaxation and/or the awareness you need you create an “anchoring” to that state. You can use a word, a gesture or even a picture that you link, in hypnosis, to the state of relaxation your client has  achieved. The patient can reproduce that state during the day: whenever and wherever he/she wants.

All the procedure takes 10 minutes. Sometimes, like you can see in the video, even less..

Thanks for reading

Davide

 

p.s. pic taken from http://fonthillcare.co.uk/activities/new-class-tai-chi/