“exercise is really for the brain, not the -john j.€¦ · chronic pain specialty certificate...

Chronic Pain Specialty Cert Course ATRI, Chicago Nov 2013

Donna Adler, B.A., ATRIC AquaStretch™ Trainer [email protected] 1

Chronic Pain Specialty Certificate

2013 National Aquatic Therapy Conference

Chicago, IL

November 21-22, 2013

Faculty:

Connie Jasinskas, H.B.Sc., B.Ed., M.Sc.

Donna Adler, B.A., ATRIC, Personal Trainer


•  The Human Body

•  Complex Interflowing Streams of Moving Energy

•  Constricted/Blocked Energy:

•  Emotional/Physical/Mental Fluidity Lost

•  Pain/Discomfort/Illness/Distress

•  When Congestion Lasts Long Enough


•  Movement is Essential to Learning & Life Itself

•  In Stillness...Body Moves

•  Expansion/Contraction of Lungs & Muscles

•  Digestion of Food/Heartbeat/Nerve Impulses

•  Movement Anchors New Information & Experience

•  Into Neural Networks


• “Exercise is really for the brain, not the body. It affects mood, vitality, alertness and feelings of well-being.”

   -John J. Ratey, MD, Harvard Medical School

Intuition “The Still Small Voice Within”

•  Natural - Cognitive Mind Connects •  Collective Consciousness •  Thoughts Pass from Unknown & Unseen: •  Into the Known and Seen •  Separate from logical/cognitive mind •  An Insight/No Reasoning/Analysis

Intuitive Skills •  Intentional Sequencing©

•  Set Intention

•  Listen with your Eyes, Ears & Heart

•  Listen with your Fingertips!

•  Are you taking an Engineer or Artist Approach?

•  Follow the Breath



Intuitive Skills

•  Skilled Hands Key

•  Effect Positive Change

• Reprogram Mind-Body

• Contact/Movement

•  Intentional Sequencing/AquaStretch™

Intuitive Skills

• Therapist May Feel... • Gristly/Bubbly Sensation (Foot) • Marble Like • Rubber Band (or a few) • Ball W/Gooey Substance that slips away • May Feel like Zinging Sensation

Intuitive Skills Accentuation of Movement

• Move If You Feel The Need to Move”

• Accent for Greater Effectiveness

What If the Patient is Immobile?

•  Use Intentional Movement to Illicit Intuition

•  Therapists Need to Find the Stillness Within

•  V-Spread With Gentle Pressure

•  Think 3-Dimensionally

•  Use Craniosacral Rhythm/Pulse


 Purpose: To Gain Insight Locating Adhesions

 Directions: Assessing Client/Patient

 Look Where They Place Their Hands

Oscillation: Benefits

  Increased Blood Flow

  Reduction in High Blood Pressure

  Stress Alleviation

  Produce a Meditative Response

  Emotional Balance

  Relaxation

  Peacefulness




  Increased Blood Flow

  Reduction in High Blood Pressure

  Stress Alleviation

  Produce a Meditative Response

  Emotional Balance

  Relaxation

  Peacefulness


•  Muscle Health…

•  Soften & Relax Injured & Overused Muscles

•  Releases Endorphins

•  ROM

•  Reduction in Pain

Intentional Movement

• Diagnostic to identify fascial adhesions • Trigger intuitive motion

• Neurological Issues? • Breath as the Fulcrum

Intentional Sequencing©

• Contract Relax • Oscillation • Spirals • Intentional Movement

Intentional Sequencing© is a copyright of TradeMarc West, Inc., dba Liquid Assets for Fitness, 2013

Contract-Relax

• Elicited referred pain pattern • For active Myofascial trigger points • Pain is familiar to the patient/client • Kinesthetic Awareness • Contract/Relax

Contract-Relax

• Excessive Release of Acetycholine • Involved Motor Endplates • Dramatic increase in motion • Increased Evidence of Electrical Activity •  Contralateral Limb • 29 of 30 Patients

(Simons, DG, Mense S., PubMed Dec. 2003, Diagnosis and treatment of myofascial trigger points.)



Intentional Sequencing© Teeth Grinding/TMJ Grip

 Craniosacral Ear Pull:

•  Activates TMJ (Temporal-Mandibular Joint)

•  Cranial Nerve Trunks Run Across Joint

•  Gain Sensory Info From all Over the Face, Eye Muscles, Tongue, Mouth

•  Activate all muscles of Face for Expression, Mastication, Vocalization

Intentional Sequencing© TMJ/Teeth Grinding (For Persistent Pain)

Patient: Standing, Sitting, Supine

Therapist: Proximal thumb/fingers: On zygomatic process

Support Chin Apply Gentle Pressure

(5-10 Sec.)

Intentional Sequencing© (For Persistent Pain)

Considerations: Masseter TMJ/Teeth Grinding

Tinnitus “Sinus” Pain Over Eyebrow

Toothache

Triggerpoints.net

Intentional Sequencing©

TMJ/Teeth Grinding (For Persistent Pain)

Considerations: Upper Trapezius Tension Headache

“Bursitis” Goosebumps to Upper Arm/Thigh?

Nausea Visual Disturbances

Strain – SCM/Scalene Muscles

Triggerpoints.net

Considerations: Sternocleidomastoid Dizziness Nausea

“Migraine” Vagus Nerve Involvement

Neurological & Pain Symptoms

Intentional Sequencing©: Migraine/Dizziness/Nausea (For Persistent Pain)

Triggerpoints.net

Iliotibial Band Pain Contract Relax Oscillation

Consider Comfort Seated/Supine

Use Therapist’s Leg



Low Back/Persistent Pain

Back Against The Wall

Intentional Sequencing© Sciatica/Piriformis Syndrome

(For Persistent Pain) Considerations:

Seated or Standing? Abd/adduction

Contract Relax Oscillation

Intentional Sequencing© Trap/Scap Release (For Persistent Pain)

 Patient: Supine - grip at the wall  Therapist:  Traction to the proximal arm   Intuitive movement? Or Breath?  Therapist’s grip on/near   the Wrist/Extensors  Oscillation w/Traction

Contract Relax Oscillation

Intentional Sequencing© Carpal Tunnel/Wrist/Hand Pain

(For Persistent Pain) Patient: Supine with a neck collar.  Use leg floats as necessary. Therapist: Intentional Sequencing   Find Tender Points Consider: Interossi, extensors, fingers,

thumb Apply Contract/Relax with Wrist Extension/Flexion, and finish with Oscillation

Therapist Back Against the Wall Option

Contract Relax

Oscillation

Upper Extremity Intentional Sequencing© (For Persistent Neck/Shoulder Pain)

 Patient: Supine/Kneel

 Therapist: Traction proximal arm

 Palpate area of tension/pain?

 Neck Lateral Flexion

 Internal & External Shoulder Rotation

 Instruct Client to Point Fingers Up, then Down

 Repeat with external rotation

Contract Relax

Intentional Sequencing© Upper Extremity

Contract Relax

Wrist Flexion/Extension

Upper Extremity Intentional Sequencing©



Intentional Sequencing© Upper Extremity   Shoulder Elevation

  Lateral Neck Flexion

  Scapular Protraction/Retraction

  Shoulder Depression

  Shoulder Horizontal Abd/Adduction

 

Contract Relax

Lateral Neck Flexion w/Traction

START POSITION

W/TRACTION

1. TRACTION 2. SHOULDER INTERNAL & EXTERNAL ROTATION 3. WRIST FLEXION &

WRIST EXTENSION

Intentional Sequencing© NECK/SHOULDER

Contract Relax

Intentional Sequencing© NECK/SHOULDER

1. TRACTION 2. FIND TENDER POINT?

3. SHOULDER INTERNAL & EXTERNAL ROTATION

4. WRIST FLEXION & WRIST EXTENSION

Lateral Neck Flexion w/Traction

Find Tender Point? Move Slowly

Intentional Resistance in Wrist Flexion/Extension?

Contract Relax

Oscillation

Psoas Release Chronic Pain/Wheelchair

 Client/Patient: Supine w/neck collar

 Therapist: Back Against the Wall Position.

 Find Tender Spots

 Use V-Spread

 Find Craniosacral Rhythmn


 Trigger point defined: “a hyperirritable spot in skeletal muscle that is associated with hypersensitive palpable nodule in a taut band. The spot is tender when pressed, and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena”

Simons Dg, Travell JG, Simons LS. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger point manual. Vol. 1: Upper Half of Body. 2nd ed. Baltimore, MD; Williams & Wilkins, 1999New research on myofascial trigger points:

Suggests that MFTrP are evoked by abnormal depolarization of motor end plates. McPartland JM, Simmons, D. (2006) Myofascial trigger points: translating molecular theory into manual therapy. The Journal of Manual and Manipulative Therapy. 14(4): pp 232-239

Psoas Release – Other Considerations: Trigger Points

Source: Triggerpoints.net



Neuronal Plexus Site Network Dense w/Neuropeptide Transmitters

All Connected - All Affect Each Other

Nodal Points of Electrical/Chemical Activity Receive/Process & Distribute Information

To the Body/Mind


“Stress” activates Dis-Ease “Pain” responds to Stress

Chronic Pain Specialty Certificate Diaphragmatic Breath Activates Vagus Nerve

“ACTIVATING THE VAGUS NERVE CAN STIMULATE STEM CELLS TO

PRODUCE NEW CELLS AND REPAIR AND REBUILD

YOUR OWN ORGANS.”

Sloan, R. P., et al. 2007. RR interval variability is inversely related to inflammatory markers: The CARDIA study. Mol Med 13 (3-4):178-84.!"Ultra-Longevity" by Mark Liponis, MD!"Prime-Time Health" by William Sears, M.D. with Martha Sears, RN!Pavlov, V.A., and K.J. Tracey. 2005. The cholinergic anti-inflammatory pathway. Brain Behav Immun 19 (6):493-99.!Theise, N.D., and R. Harris. 2006. Postmodern biology:(adult) (stem) cells are plastic, stochastic, complex, and uncertain. Handb Exp Pharmacol (174):389-408.!Your Brain on Food by Gary L. Wenk!Fighting Cancer — A Nontoxic Approach to Treatment by Robert Gorter, MD, PhD and Erik Peper, PhD

“exercise is really for the brain, not the -john j.€¦ · chronic pain specialty certificate...

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