Understanding Movement Confidence and Managing Flare Ups in Rehab (Part 4) — Transcript

Full transcript

1. 0:01So movement confidence is the fifth and
2. 0:03final pillar.
3. 0:05Movement confidence is really important
4. 0:07to understand that this is not always a
5. 0:11problem for most people.
6. 0:14I would say 50% of the time someone
7. 0:16might come in because their back hurts,
8. 0:18but when you go through that standing
9. 0:19assessment, there's no problems. They'll
10. 0:21often cause it they'll often call it the
11. 0:24physio's curse. They'll come in and
12. 0:26they'll have no pain.
13. 0:28Take that individual and understand that
14. 0:30hesitation and guarding is clearly not
15. 0:32their problem. So they can move fine. So
16. 0:34this might not be a neurological
17. 0:35problem. This is most likely capacity.
18. 0:39If you're someone that comes in in a lot
19. 0:41of pain and you're terrified to bend and
20. 0:43you're terrified to touch your toes,
21. 0:44which we see a lot, that's when we look
22. 0:47at is this structural or is it
23. 0:49neurological or is it both. You'll find
24. 0:52that the hesitation might improve as you
25. 0:54do more reps. This is when we understand
26. 0:56this is just a nervous system doing its
27. 0:58job. It's protecting you because it
28. 0:59thinks moving and bending is a threat.
29. 1:02However, the nervous system at this
30. 1:04stage is now flagging things that are
31. 1:06dangerous when they're not dangerous.
32. 1:08That's a protective mechanism and that
33. 1:10itself builds a vicious cycle.
34. 1:13This leads on to fear avoidance. This is
35. 1:16a behavior that is generally going to
36. 1:18happen with most people who are avoiding
37. 1:20movements because they know it might
38. 1:21hurt. They might not go to the gym
39. 1:22because it hurt, might never deadlift
40. 1:24again because it hurts. These are common
41. 1:26problems we have to address.
42. 1:29And so this is why rehab needs to be
43. 1:31built around graded exposure. We need to
44. 1:34gradually build that movement you're
45. 1:36terrified of safely, confidently, and
46. 1:40with objectivity.
47. 1:42If you can't touch your toes, I'm going
48. 1:44to eventually get you to the point where
49. 1:45you could touch your toes 20 times
50. 1:46within one set. And this is why it's
51. 1:48such an important pillar because someone
52. 1:49can come in and move with no hesitation.
53. 1:52That's where we need to appreciate that
54. 1:53pain is not a KPI we have to trust all
55. 1:56of the time. This leads all the way back
56. 1:58to pillar one. And this is where we go
57. 2:00on to two case studies that we've had
58. 2:02recently come into the clinic of two
59. 2:04amazing clients that we've worked with
60. 2:05prior. Now, the first case study is an
61. 2:08individual who's active. They're always
62. 2:10training. They're always doing
63. 2:12something. They were brilliant through
64. 2:14the first rehab process where they had
65. 2:16earned the right to go back to what they
66. 2:17loved doing. They noticed a symptom,
67. 2:21something wasn't right, but they ignored
68. 2:22it. They didn't make any contact. And
69. 2:24what we found over the last couple of
70. 2:26months, that pain started getting a
71. 2:28little bit worse, a little bit worse,
72. 2:30until one awkward movement created a
73. 2:32flare up. We had a sit down. We talked
74. 2:34about their problems. They talked about
75. 2:36their goals. We talked about what they
76. 2:38were doing when they were previously
77. 2:39with us and what they stopped doing
78. 2:41between then and now. We figured out
79. 2:44that two of the five pillars were not
80. 2:46addressed. And this unfortunately must
81. 2:48have been enough for that flare up to
82. 2:50reoccur. Within the first couple of
83. 2:51weeks of the rehab process, we built
84. 2:53pillars back up and we've slowly started
85. 2:55seeing them back to normal training,
86. 2:57back to squatting, back to doing what
87. 2:58they love doing with confidence. But now
88. 3:00they know that all five pillars need to
89. 3:03be actively managed and we've given them
90. 3:04the strategy to do so. The second case
91. 3:07study is a bit fresher. Now, this
92. 3:09individual had a really, really
93. 3:10significant disc herniation and a very,
94. 3:12very long rehab process with us. We got
95. 3:15them to the point where they could gym,
96. 3:16they could golf, they could do
97. 3:18everything they wished to do.
98. 3:20Unfortunately, 7 months ago, they had a
99. 3:22bit of a change in job. They had a
100. 3:24change in stress. They had a change in
101. 3:26lifestyle. All of these added up and
102. 3:28little niggles started reoccurring. They
103. 3:31didn't make any contact. They just
104. 3:32thought it would go away. Now what's
105. 3:34really important is we went through the
106. 3:36five pillars and unfortunately every
107. 3:38single pillar was lost and this is just
108. 3:40true life. Things change, life changes.
109. 3:43We just need to be really consistent and
110. 3:45understanding that habits need to be
111. 3:47maintained.
112. 3:49They came back to us and now we're in
113. 3:51the acute stage of just earning the
114. 3:53right to get their movement pattern
115. 3:54safely back from the ground to standing
116. 3:56to the gym. This is something that will
117. 3:58take up to 4 to 8 weeks to fully return
118. 4:01back. However, those pillars will no
119. 4:04longer be forgotten. And sometimes
120. 4:06flare-ups like this teaches you not to
121. 4:09ignore those signs in the future. It's a
122. 4:11harsh rule of life.
123. 4:15So, to finish, this is where I really
124. 4:17want you to reflect. Flare-ups are
125. 4:20common. I've had flare-ups. Flare-ups
126. 4:23will happen in people's lower back rehab
127. 4:25journeys. If you've had multiple
128. 4:27flare-ups, I want you to reflect on
129. 4:29those five questions. Are you tracking
130. 4:30and adapting your total weekly demand?
131. 4:34Have you progressed through all three
132. 4:35phases of your trunk capacity? If so,
133. 4:38retest. Can you still do phase one? If
134. 4:40not, go back, work on them, make sure
135. 4:43that they're in your training volume and
136. 4:45your training plan. Third, training
137. 4:48consistency. Are you still actively
138. 4:50hitting 80% of your planned sessions?
139. 4:53When it comes to recovery, is everything
140. 4:55still in check? Is your sleep,
141. 4:56nutrition, and stress management still
142. 4:58being dialed in? And finally, movement
143. 5:00confidence. Are you moving with
144. 5:01thoughtless, fearless movement, or is
145. 5:03there slight hesitation or fear starting
146. 5:05to creep slowly back in? If so, do not
147. 5:08hesitate. Get in touch. I really hope
148. 5:11you guys enjoy this video. Looking
149. 5:12forward to hearing from you guys. Have a
150. 5:14wonderful rest of your day.