Definition: the mind's ability to consciously, or unconsciously, adjust and relate the body to its social environment
After reading Craig Liebenson's, Rehabilitation of the Spine- A Practitioner’s Manual, this term has become extremely important in how we categorize dysfunction and decide what approach needs to be taken. In this text he describes how treatment for painful or non-painful patterns is not always a biomechanical problem. Liebenson’s suggestion is to use an assessment that first rules out most extreme causes such as cancers and nerve damage. The next step is to look into not only how the person moves, but also his perception of his environment/self. The term environment defines one’s interaction with his surroundings, while self would be in context to how one sees his own abilities (Examples: my back hurts from lifting chairs up, I never will be able to succeed). In doing so, we can more accurately help people return to functioning on a higher level. In the next paragraphs we will see how this concept can impact your own path through training and life.
How does this concept play into painful and non-painful patterns?
First, painful patterns are for the medical community to treat. If you have pain you should have a skilled practitioner assess the problem. A fitness professional’s role is to design a program for after a person has been treated. However, if a client is cleared of any biomechanical issues, and yet there is still an issue with movement or pain then there might be another avenue to look into. In Rehabilitation of the Spine many of the studies and references show a clear depiction of how low back pain is not always an issue that can be seen on an MRI or x-ray. In most cases people that have no pain can show the same imaging as people with pain. If this is the case, then a biomechanical model cannot be used to diagnose the problem or correct it necessarily. This is where using a different screening process can be helpful.
An example of this would be if a client who recently had an acute low back pain episode, but is now pain free, starts to exercise. The program needs to be in-line with how the individual perceives movement/himself. If he hurt himself bending over to pick something up, than any exercise that mimics bending might be a tough sell. Fear avoidance is an extremely powerful mechanism in terms of inhibiting motor patterns. Even though there is currently no pain, the client has learned to be fearful of that particular pattern. In addition, due to the avoidance of the painful pattern, he has developed compensatory patterns. This tends to create a cycle of overuse in particular muscles that lead people to have chronic pain. This is where a combination of understanding what pattern is being avoided, and also reassuring the client that he is able to perform the task without further damaging himself is critical. A skilled trainer will not only be able to find the painful pattern and start to retrain it, but also find other dysfunctional patterns feeding the problem. This is an example of how the biomechanical and psychosocial models interact. We have to understand that proper movement based on a biomechanical model is only uploaded if the client believes it is working and is motivated to do it.
Is this something only a fitness professional should be aware of?
Definitely not. In some research cases presented in Liebenson’s book, depression was a better indicator for chronic low back pain than an MRI. Patient outcome was better with practitioners that were able to get the person to take an active part in his own recovery. It may sound obvious, but most people don't ever consider that if the person doesn't believe the treatment will work, it probably won't. “I went to PT, a personal trainer, doctor etc... before and they didn't do anything.” This mentality has already set the client down a path of neither trusting nor being open to suggestion. The mental battle that a person will have to go through, if they are trying to exercise with the belief that movement will hurt them is a never ending one.
Having a sound, valid biomechanical screen can help you quickly rule out the issues that can be solved with some simple choice correctives. When combined with a sound psychosocial plan based on trust and motivation, there isn't much you have left out.