+ Counsel about activity Lori Montgomery MD CCFP Clinical Lecturer Depts of Family Medicine and...
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+ Counsel about activity Lori Montgomery MD CCFP Clinical Lecturer Depts of Family Medicine and Anesthesia, University of Calgary Medical Director, AHS Chronic Pain Centre
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Transcript of + Counsel about activity Lori Montgomery MD CCFP Clinical Lecturer Depts of Family Medicine and...
+Counsel about
activity
Lori Montgomery MD CCFPClinical LecturerDepts of Family Medicine and Anesthesia,University of CalgaryMedical Director, AHS Chronic Pain Centre
+ Disclosures
Grants/Research Support: NoneSpeakers Bureau/Honoraria: None Consulting Fees:None
+ Disclosures
Prepared with assistance from:
Jennifer Greenlay, kinesiologistShannon Rogers, kinesiologistSafa Rahman, physiotherapist
+ What a rehab professional might do:
•Examine assumptions about activity•Set functional goals•Discuss an approach to beginning exercise•Help to troubleshoot problems with exercise•Introduce concepts of core stability
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+
Black-and-white thinking
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+
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“Do it, no matter what”
+ “Do It No Matter What” Thoughts
“I’m fine. I just need to try harder.”“I should be able to do this.”“I have to do it this way.”“Others (kids, spouse, employer, parents) need me.”
“I’ll rest when I finish this.”“I feel more pain when I stop, so I’ll just keep going.”
Time
Activity Level
Tolerance
“Do It No Matter What”
“Do It No Matter What” and Function
+
“Wait until…”
+ “Wait Until” Thoughts:
“What if I cause more damage and make my pain worse?”
“This is really going to hurt.”
“If I can’t do it like before, what’s the point?”
Time
Activity Level
Tolerance
“Do it no matter what”
“Wait Until”
“Wait Until” and Function
+ Pacing Approach
Time
Activity Level
Tolerance
“Do it no matter what”
“Wait Until”
Pacing
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Hurt = Harm
+ Pain is an alarm
+Pain is an alarm
Start with a level of activity that doesn’t flare your pain by more than 3 points
Start with a level of activity you could do even on a bad day
Start with a level of activity that feels safe
+Pain is an alarm
Increase by 10% in either frequency or intensity every week/month etc.
Aim to do your activity every day
Once you’ve progressed, have a back-up plan for days when pain is flaring – still active daily
+ “Four food groups of exercise”
•Aerobic•Muscular Strength and Endurance•Core stability•Flexibility and Joint Range of Motion
+Core Fundamentals
+Core Fundamentals
• We describe the “core” like a pop can
• Diaphragm• Deep abdominals• Deep back muscles• Pelvic Floor
• All sides of the canister (muscles) need to be able to accommodate and adapt to pressure changes within the abdominal cavity
+Core Fundamentals
• “Core Stability” describes a dynamic system that responds to change
Think of it as “Core Control”
+Core Fundamentals
The “Crushed pop can”
+Core Fundamentals
+Advice for Patients
Elongate spine
Lift ribcage away from pelvis
Engage core muscles
Practice breath awareness
Practice proper body mechanics
+When you have back painThink about using legs, gluteals instead of back muscles (rising and sitting)
Unlock the knees
Pay attention to stance and gait
