Sunday, March 8, 2015

Review: A Guide to Better Movement

A Guide to Better Movement
The Science and Practice of Moving with More Skill and Less Pain
by Todd Hargrove, CR, CFP

In my personal training and bodywork practice, the importance of quality of movement -incorporating mobility, strength, balance, and variety- continues to evolve and become paramount to my approach. Combine an interest in understanding and managing pain, and this book becomes a perfect match for my professional interests. I think anyone involved professionally with movement or pain treatment, or personally interested in those topics, will find it equally important.

The book has three parts:
  1. The Science of Moving Better
  2. The Science of Feeling Better
  3. The Practice of Moving Better and Feeling Better

Part 1 discusses concepts about how the many parts of the body can coordinate to create good movement.

Some things desirable for good movement are being efficient and reducing unnecessary action, responsive to the environment, functional, and safe. Movement patterns should be variable, so that there not a single fixed way to perform an action, and feel good to do,

This is part of development from infancy. How we move is not built-in, it is learned through experimentation and feedback. How we perceive the body is also learned, and like movement, it can change.

As part of this learning the brain creates a map the body, forming perceptions that are how we consciously think of the body, which are influenced by sensations from the body. To rephrase- sensations are signals from the body, perceptions are interpretations based on sensations and several other factors(more about this in a moment). The quality of the body's movement depends on the accuracy of this map.

The way to build accurate maps of the body is to move and to get sensation back from the body(proprioception). More movement means a better map, which means better movement, with more pleasure in movement, and better performance. Attention is important, so mindful movement and focus help to form a good map. Stimulus from movement that is relevant to some task will also do more than passive and arbitrary inputs to the body. If a baby wants to explore, crawling will provide a very rich learning experience in movement and body map development because of its relevance to exploration.

Pain however, distorts the map and discourages movement. Less movement leads to a less accurate map, and the dysfunction spirals downward.

Part 2 deals with understanding pain, and how to experience less of it.

The modern theory of pain science is known as the pain neuromartix.
"The neuromatrix helps explain the relationship between pain, tissue damage, sensory signalling, perception, movement, thought, and emotion."
In other words, pain is an experience dependent on many factors, and is not a direct measurement of tissue damage. This is a major departure from older theories, and the often compelling message we feel. This does not in any way suggest pain isn't real, but that it is not an accurate measure of damage of the body. Pain is the mind's way of getting attention for a perceived threat, such as moving a body in a way that might increase existing damage, or recreate a situation which caused damage before.

Making things worse, pain can be increased by sensitization, the process whereby the amount of negative stimulus required to cause perception of pain decreases, and the perceived intensity increases. What may have seemed a minor discomfort before an injury can seem much worse afterwards, even when the tissue is fully healed. The mind is just more protective now.

Now that the connections of the nervous system with movement and pain have each been discussed is the most interesting part of the book to me: Learning how changes in movement and pain sensation affect each other, and how to use this to overcome limitations one may cause in the other.

In the body, pain can do several things. Pain inhibits strength. If a movement is associated with pain, it isn't possible to apply as much strength to it. Pain also reduces flexibility. The brain is trying to do anything it can to avoid what it believes could cause injury, and reducing strength and range of motion are two of its methods. (An interesting side note: The primary change from stretching isn't changing the physical properties of the tissue, it is increasing stretch tolerance, which is how elongated the tissue can be before pain occurs.) Pain also decreases endurance, and creates a sensation of fatigue.

The physical state of the body, and the mental state, interact bi-directionally

To move better, decrease pain. To decrease pain, create controlled, safe movement with feedback.

Some specific strategies
Move slowly and gently. Pain is a threat warning, so give the mind time to process the change in the body, and don't make the change extreme.

Use graded exposure. Introduce movements that have problematic in the past progressively. The nervous system will gradually learn that the movement is safe, and be less likely to feel pain.

Novelty. Sometimes exploring new movement patterns gets more attention in the brain and overcomes habitual patterns that are problematic.

Create movement with abundant proprioception AND

Use developmental(as in learning to move as an infant) positions and movements. Developmental movements are typically done on the floor. The floor provides constraint, therefore less threat of moving too far, and less need to create stability internally. Touch sensation from the floor is a strong source of feedback, greatly improving the map of the body formed in the brain. Better map, less threat, and less pain.

Avoid pain in movement. Don't reinforce the association of the movement with feeling pain. Also avoid fatigue, which can make it harder to focus and learn new motor patterns and body maps.

My speculations
It is my opinion that external sensation while being firmly supported is a major reason for the success of many bodywork therapies. The controlled manipulation of tissue and facilitated movement during massage, while lying on a table, is one example. Another is in restorative and yin yoga, which combine yoga positions with supporting bolsters to provide safety from stretching too far, but also give tactile feedback. Furthermore, both bodywork and yoga are usually done in an environment promoting relaxation with the guidance and reassurance of a professional. The mind associates the movement, position, and sensation with security instead of pain.

I even think one of the reasons that gym 'machines' remain popular is that they give both constraint and tactile feedback during the exercise. To someone worried about injury these can be very reassuring compared to simply standing and picking up a weight. (In a rehab scenario this may be beneficial, but otherwise could hold back someone's mobility and strength development.)

Part 3 gives example lessons to improve fundamental movement patterns and perceptions of movement. The exercises are from the Feldenkrais Method, which Hargrove teaches. Most are done lying or kneeling on the floor without equipment, with a very gradual and mindful approach.

I have used just a couple of these- the typical client coming to me for personal training doesn't need to practice the rudiments of movement(or isn't interested if they do). I do want to borrow from the lessons to expand the mobility drills I use though. For people with enough motivation and limitations to movement I think these lessons would be more important.

Get A Guide to Better Movement: The Science and Practice of Moving With More Skill And Less Pain and start helping yourself and your clients move and feel better.

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