In August I attended the NOI Groups’ two day Explain Pain course, followed by the one-day Graded Motor Imagery course. While there is a plethora of fantastically interesting knowledge that I gained of the current science and understanding of pain and stress biology that I would love to go on and on about, I am choosing to spend some additional time sharing my reflections on the biopsychosocial treatment approach that is Graded Motor Imager (GMI).
So, firstly, what is GMI? For those of you who haven’t heard of it, GMI is a series of progressive cognitive activities that are all about virtual movement and accessing your body’s representation in the brain, to assist in improving your pain state, especially when movement itself is very limited by the pain experience. The three main techniques are Implicit Motor Imagery, Explicit Motor Imagery, and Mirror Therapy. In brief (VERY brief):
- Implicit Motor Imagery – identifying whether a limb is left or right, or in the case of the spine, whether a person has turned to the left or the right. When considering this question, the brain actually goes through the mental (and sometimes physical) transformation to confirm the choice.
- Explicit Motor Imagery – imagining movements and postures (ideally in the first person). There is a high degree of overlap in brain regions involved in observed movement, imagined movements, and actual movements. By imagining a movement, we have activated some of the same motor regions of the brain activated during actual movement, and we have just graded the exposure of the neuroimmune system to movement without physically moving.
- Mirror Therapy—the use of a mirror to present the reverse image of a limb to the brain, thus “tricking” the brain into thinking that limb is moving. When viewing a body part in a mirror there is activation of the motor cortex in both the brain areas corresponding to the moving limb as well as the other limb (which is hidden). Again, another way of grading the exposure of the neuroimmune system to movement, without actually moving.
The idea is that by rehearsing movement and activities that might be too painful for the individual to physically do, in a way that is completely safe and unable to cause further physical damage, we can begin to adapt and retrain the neuroimmune system and change the experience.
Sound a bit hokey? Well, without integrating modern pain science and a baseline level of understanding of the neuroimmune system with the GMI techniques, it will definitely seem hokey to anyone you ask to imagine themselves doing something with the expectation that it will resolve their pain. Which brings us back The Explain Pain intervention and my biggest personal take away from the weekend.
During my University Basketball career in Canada (Go VReds!), we used implicit and explicit motor imagery all the time in the form of watching film of professionals, watching film of ourselves performing both small aspects of the game (i.e. shooting mechanics) or short clips of the game itself, and lastly through visualisation (until attending this course, my least favourite technique). At that time, I used to moan about watching film, cringe when I saw myself make a mistake, and frequently fall asleep when I was meant to be visualising myself achieving success on the basketball court. I didn’t appreciate that these techniques were what pushes good athletes to become great athletes. By accessing your body’s representation in the brain between practice sessions and games, you can maximise your potential beyond what you can achieve through physical practice alone.
The fact that I didn’t get to fully take advantage of these tools that were put in front of me to improve my performance falls right in line with what I believe happens for a lot of people experiencing pain, and is what The Explain Pain intervention is built upon: Knowledge = Power. I didn’t fully understand howmy brain worked when it came to motor learning and howthose mumbo jumbo visualisation and video sessions would be effective in improving my performance, so I didn’t properly master the techniques and I didn’t reach the level of success in sport that I hoped I would (my abysmal free throw shooting percentage is evidence of that!). I went through the motions and completed all of the visualisation and imagery tasks that my coaches put in front of me (I wasn’t risking any extra running), but I wasn’t making the gains I likely could have made if I understood at that time, what I understand now about the brain and neuroimmune system.
Similarly, I see many clients diligently complete all of the treatment protocols and physiotherapy exercises that are the best practice interventions, because their treatment provider told them to. But for some reason, at the end of it, they haven’t experienced the improvements in function or in their pain experience that they were expecting and hoping to make. Can we, as health practitioners, improve their outcomes by helping clients to understand what is going on in their body when experiencing pain? The answer is YES. But first, we need to truly understand it ourselves, and understand that we can play a pivotal role in giving our clients the key to unlocking the mystery behind their pain and debunking some of the unhelpful beliefs and ideas they may have picked up along the way.
So for any health practitioners out there, who play any form of role in someone’s recovery after an injury or illness, I encourage you to look into Explain Pain. I promise you, it is not your average research article or textbook. It is engaging, humorous, and approachable, and will hopefully help you to feel better equipped to answer those tricky questions from clients looking to learn more about “why this hurts more when I do that, or am feeling this, or am even thinking about going back to (insert activity)!”
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