Pilates for Central Sensitization from Chronic Pain .Pilates for Central Sensitization from Chronic

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  • PilatesforCentralSensitization

    fromChronicPain

    ElizabethClark

    March18,2016

    FlowStudios,Chicago,2015

  • 2

    Abstract

    Centralsensitizationisaconditionofheightenedsensitivity,closelyassociatedwith

    chronicpain.Inthisstate,thebrainisbeingtoldthatthebodyisinmoredangerthanit

    actuallyis,maintaininganongoingstateofstress.Muscleactivity,brainfunctionand

    emotionalwellbeingarenegativelyaffected.Individualsexperiencingchronicpainand

    centralsensitizationusuallyattempt,unsuccessfully,toeitherpowerthroughtheir

    symptomsoravoidpainfulactivitiescompletely.Abetterconditioningmethodhasproven

    tobetheslowandsteadyapproach.Thiscasestudyexaminestheeffectsofapersonalized

    BASIPilatesprogramonaclientwithchronicpainandasensitizedcentralnervoussystem.

  • 3

    TableofContents

    CentralSensitization....................................................................4

    CaseStudy..............................................................................8

    ConditioningProgram....................................................................9

    Conclusion.............................................................................11

    Bibliography............................................................................13

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    CentralSensitization

    Thecentralnervoussystem(CNS)ismade

    upofthebrainandspinalcord.Working

    withtheperipheralnervoussystem,itsjob

    istosend,receiveandprocessinformation

    fromeverypartofthebody.Adamagedor

    faultyCNS,onethatdoesnthandle

    informationcorrectly,canleadto

    symptomsrangingfromaheadache,to

    slurredspeech,toradiatingbackpain,to

    numbness,tolossofcoordinationto

    numerousothersymptoms.(JohnHopkins

    Medicine)ThiscasestudyinvolvestheCNS

    disordercalledCentralSensitization.

    One formof information theCNSdealswith ispain. Likemost stimuli, pain travels from

    peripheralsensoryneuronstothespinalcord,andthenonuptothebrain.Thebrainsjob

    is to interpret the information andmake a variety of short and long-term responses by

    sendinginformationbackthroughthespinalcordtothebody.

    Ifthespinalcordcontinuallyreceivespainstimulus,theveryadaptablenervoussystem

    respondsbygettingbetteratsendingdangersignalstothebrain.Thingsthatusedtohurt

    begintohurtmoreandthingsthatpreviouslydidnthurtstarttocausepain.(Butler,

    Fig.1:http://climatereview.net/ChewTheFat/?p=1015

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    Moseley73)Thebrainisbeingfedinformationthatnolongerreflectstheactualhealthand

    abilityofthetissues.Itsbeingtoldthereismoredangerthantherereallyis.Althoughthe

    levelofsensitizationvaries,heightenedsensitivityoftheCNSisalmostalwaysasymptom

    ofchronicpainatsomepoint.And,thelongerthepainlasts,thegreaterthechangesinthe

    CNSbecome.(Ingraham)

    Commoncharacteristicsofcentralsensitizationincludethefollowing:

    - Thepainlastsafteraffectedtissueshavehealed.

    - Thepainspreadsbecausethebrainisincorrectlybeinginformedthatmoreof

    thebodyisindangerthanactuallyis.

    - Thepainincreases,sendingamessagesayingtoescapetheperceiveddanger.

    - Assensitivityincreases,theamountofmovementrequiredtoignitepain

    reduces.Inseverecases,eventhinkingaboutamovementcancausepain.

    - Thepainbecomeslesspredictable.

    - Thepainlinksmoretothoughts,feelingsandbeliefs,whichinturnstart

    contributingtotheproblem.(JohnHopkinsMedicine)

    Inresponsetochronicpain(thebrainreads:chronicdanger)plusasensitizednervous

    systemmagnifyingtheissue,manyadaptationscanoccur.Oneisalteredmuscleactivity,

    specificallyactivationofthelongermovermusclesanddeactivationoftheshorter

    stabilizermuscles.Intheshortterm,thisisagoodresponsetodanger.Thebrainis

    preppingthebodytofightorflee.Inthelongterm,however,thisstatenegativelyimpacts

    postureandmovementpatterns.Theactivatedlongmusclesbecometightandthe

    deactivatedshortmusclesbecomeweak.(Butler,Moseley90)

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    Anotheradaptation,onethathappensinasectionofthebrainscortexcalledthe

    homunculus,isknownassmudging.Areasofthebrainnormallydevotedtospecificbody

    partsbegintooverlaponeanother.Smudgingcanoccurinbothmotorandsensoryareasof

    thebrainandisthoughttobeaprotectivestrategy.Motorsmudgingmakesitharderfor

    thebraintoaccessbodypartsassociatedwithpainandthereforelimitingtheiractivity.

    Sensorysmudgingallowsthesensitivityofapainfulareatospreadtoneighboringareasin

    ordertoincreasethedangersignalbeingsenttothebrain.(Butler)

    Individualswithchronicpain,includingthosewithcentralsensitization,typicallytakeone

    oftwoapproachestodealingwithpain:avoidthepainortrytobeatit.Thosewhotakethe

    avoidanceroutestopany

    activityassoonasthepain

    kicksin.Overtime,the

    amountofactivitynecessary

    totriggerpainbecomesless

    andless,leadingtoan

    increasinglysedentary

    lifestyleandoften

    depression.Thosewhotryto

    beatthepainattemptto

    pushthroughandignorealarmsignals.Atsomepoint,thepainbecomestoomuchtotake

    andthepersonisforcedtoseverelyreducetheiractivity.Asshownintheabovegraphs,

    bothapproachesendwithaverylowactivitylimit.(Butler,Moseley107)

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    Abettermethodistousepacingandgradedexposure.Thisrequiresabalancebetween

    testingthelimitsofpainandlettingpainbethemaster.Itisimportanttoplanoutaslow,

    measuredprogressionandtrytosticktoit,ratherthanrushingaheadorcontinually

    allowingthepaintomakedecisions.And,whenthereseemtobesetbacksorpainfuldays,

    itisveryimportantnottogiveuporbetoohardononeself.(Butler,Moseley113-117)

  • 8

    CaseStudy

    Anneisa27-year-oldfemale,54tallandweighingabout115pounds.Shehasbeen

    experiencingchronicpainandinflammationinherlowerbodyforabout4years.Thepain

    beganinAnnesfeetandkneesandslowlyspreadtoincludemostofherlegsandlower

    back.Doctorshavebeenunabletogiveacleardiagnosis,thoughtheyconjecturethatitisa

    systemicissue.WhatAnneandherdoctorshavedeterminedisthatovertime,theongoing

    painhasledtosensitizationofthecentralnervoussystemandsomecompensatory

    behaviors.

    AnnebeganattendinggroupPilatesmatclassesinanefforttostayinshapewhilebeing

    forcedtogiveuptheformsofexerciseshehadpreviouslyenjoyed(running,biking,

    volleyball)duetotheiraggravatingeffectsonherpainlevels.Morethanjusthelpingto

    buildstrengthandstayfit,Annefoundthatshealsoexperiencedreducedpainfollowing

    mostclasses.Theimprovementwouldlastforanywherefrom2-24hours.

    Givenhopebythis,AnnedecidedtotakeprivatePilatessessionswiththegoalofsoothing

    hersensitizedcentralnervoussystem,continuingtobuildstrength,andimprovingher

    qualityoflife.Anneisatalow-intermediatelevelandrequiresextrawarm-upexercisesas

    wellasaverygradualprogressioninintensity,toavoidtriggeringpain.Sheisnewtoallthe

    Pilatesapparatusbesidesthemat.Fromherassessmentsession,Ialsonotedaneedfor

    greatercontrolandstabilization,morecoreenduranceandbetterco-contractionof

    musclesduringmanyexercises.UtilizingtheBASI(BodyArtsandScienceInternational)

    BlockSystem,Ihavedesignedaconditioningprogramwiththefollowingfeatures:

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    1. Amplewarm-upexercisesandpreparatorymovements,concentratingAnnesmind

    onherwholebodyratherthanjustthepainfulparts.

    2. Agradualbutconsistentincreaseofintensity,toavoidtriggeringpainflare-ups

    whilenotallowingthepaincycletoinhibitprogress.

    3. Emphasisonstabilizationandmusclecontrolratherthanjustmovermuscle

    strength.

    4. Functionalworkinallplanes,translatingtopropermusclerecruitmentduringdaily

    activities,especiallyinthecoronalandtransverseplanes.

    5. Encouragementandpositivity!Peoplewithcentralsensitizationoftenhave

    protectivemovement-relatedpainmemoriesthatinhibitexercise,socreatingan

    environmentofphysicalandemotionalsafetyisimportant.(VlaeyenandLinton)

    Conditioning Program for Client with Central Sensitization

    Block Sessions 1-5 Sessions 6-10 Notes

    Preparation* Before all sessions: Cue client to focus on breath and move their attention throughout the whole body. Pelvic rocking, scapular protraction/retraction, point

    and flex feet, circle ankles.

    Warm-up Fundamental Warm-up Series on Mat

    Intermediate Warm-Up Series on Mat

    Start with modified versions or less repetitions, if necessary, and gradually increase. Focus on control and stability.

    Footwork Reformer: Parallel Heels, Parallel Toes, V-position Toes, Wide-V Heels, Wide-V Toes, Calf Raises, Prances, Prehensile and Single Leg Heel or Toes

    Cadillac: Parallel Heels, Parallel Toes, V-position Toes, Wide-V Heels, Wide-V Toes, Calf Raises, Prances and Single Leg Heel or Toes

    The Reformer offers an easy hip angle and the carriage supports spine and pelvis. Start on lower spring settings and work up. Focus on spinal/pelvic body stability (without unnecessary stress) and hamstring strength. Progress to the Cadillac, with a more challenging hip angle but where the client can view their leg and foot alignment easily.

    Abdominal Work

    Reformer: Hundred Prep and Hundred

    Cadillac: Roll-Up Top Loaded, Mini Roll-Up, Mini Roll-up Oblique, Teaser 1

    The hundred prep and hundred build abdominal endurance and control. The Roll-Ups and Teaser 1 increase the strength and control challenge. Teaser 1 will be an attainable goal to work towards.

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    Hip Work Reformer: Frog, Circles Down, Circles Up, Openings

    Cadillac: Basic Leg Springs Series

    Emphasize stabilizing the spine and pelvis. The Basic Leg Springs series adds the additional challenge of separately sprung legs.

    Spinal Articulation

    Reformer: Short Spine

    Reformer: Long Spine

    Once proper muscle recruitment and go