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Pain management and skill acquisition

04 April, 2017

Much of what pelvic health physiotherapists do each day relates to educating women and men in a variety of topics related to the pelvic floor. So people start with varying degrees of knowledge about say, urinary incontinence. Their current knowledge may have been acquired from their mother- “I have a weak bladder, my mother and her sister had a weak bladder, you will have issues unless you go to the toilet before you leave the house each day”. So this ‘fact’ is repeated over and over within earshot, as children grow up and it definitely sounds like gospel. It gets reinforced over the years – what your mother tells you is important and you dare not question it. The bad habit is entrenched and the ability to hold onto urine is diminished.

Many patients may have a pain issue with intercourse and any sexual intimacy. Their knowledge base surrounding sex may have acquired from their best friend, who read about intercourse in their older sister’s Cosmo and was the chief informant for the girls at school. They also may have gone to a highly religious school, where other messages about sex were preached regularly and layer upon layer of guilt regarding, even thoughts of premarital sex, were being laid down deep in impressionable brains. (‘Masturbation is a sin; you’ll go to Hell if you have sex before you are married’)

Medical people can even pass on dubious science about pain conditions. Men can be told they have prostatitis, when a more likely diagnosis may be an overactive pelvic floor causing pelvic pain, testicular and penile pain and even erectile dysfunction rather than an inflammation of the prostate.

So the point is education is very important and passing on that information and the way you do that as a health professional- is very important.

Why? Because adults are notoriously bad learners!

They may learn and understand about only 20% of anything you teach someone at an initial consultation.

Every week at our pain relaxation class, we present some Nuggets of Pain and Anxiety information – I usually create the one or two page information sheet which lasts just five minutes so that Martine Lange, one of my Women’s Health Physios and Pilates instructors can present it prior to the muscle and neurodynamic stretches, pelvic floor down-training, breath awareness and relaxation practice. After 23 weeks of preparing these, I have started to get the other physios at my practice to put their minds to coming up with some ideas for more important knowledge bombs. Amanda Quinn (nee Lee) who is another one of my Women’s and Men’s Health Physios (and also a Pilates instructor at Studio 194), came up with this fantastic Nugget from the masters of Nuggets, Dave Butler and Lorimer Moseley from their brilliant Explain Pain course. It is to outline the stages of learning information. This information was sourced from: Butler & L. Moseley Explain Pain course

Amanda’s Nugget for me:

According to Dr. Thomas Gordon, pioneer in teaching communication skills and conflict resolution (as well as a multiple Nobel Peace Prize nominee), the four stages of developing a skill set can be described below as:

Learning to manage your pain can be seen as a skill that needs to be developed – it is no different to committing to a new fitness program, learning a new language, getting your handicap down in golf… it requires time (patience), commitment and hard work. (http://fitnessontherun.net/imperative-learning-new-skill/) No one is pretending this is easy… why do you think we compare it to climbing Mt. Everest? Therefore being aware of the above stages of learning can help us better accept that it is a slow and frequently uncomfortable process.

Through hard work and persistence we can eventually hope to achieve the stage of ‘unconscious competence’. Remember, you are learning how to manage your pain through a pathway you have actually navigated countless times before when acquiring a new skill – it is no different. Don’t give up.

What is the other major benefit to learning a new skill with your health and how does it relate to pain?

Learning a new skill strengthens the connections between neurons and different areas of the brain, in fact the brain develops new pathways and synapses when learning and problem solving. This is evident when learning new movements. Exercise that involves dynamic, smooth and non-repetitive movement patterns eg. dance, yoga, certain martial arts, tai chi plus others can all help to navigate novel neuronal path ways and keep the body guessing.

It all comes back to bioplasticity.

Bioplasticity is what got you into this problem, but bioplasticity can get you out.

Dave Butler’s and Lorimer Moseley’s brand new book Explain Pain Supercharged has just been released and can I encourage any health professional working with patients who have pain, to purchase this book and enhance their repertoire of skills with these patients.

Thanks to Amanda for the inspiration for this blog on learning and I love the diagram as it can be applied to so many areas in our day educating on pelvic floor dysfunction.

 

 

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