Todd Hargrove: Pain Science and How to Be A Happy Mover (LBP 025)

Todd-21-e1415639685716-291x300Todd Hargrove of www.bettermovement.org, and author of  A Guide to Better Movement is talking about what happy movers have in common, how learning better movement is more like sculpture than painting, the feather-ruffling information that posture does not predict pain levels-and how posture still matters and why. We also dig into motor control, cortical maps, the neuromatrix model, and all kinds of wild things about how perceptual tricks affect our brain and our perception of our body which gets us asking, “What is pain really?”. Of course we also discuss what our nervous system wants from us in order to keep it from creating pain and dysfunction in the first place so that we can all be happier in our bodies.

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Show notes

Brooke: You used a great Tolstoy quote and related it to movers. The quote is , “happy families are all alike; every unhappy family is unhappy in its own way.” and you write that the same is true of happy and unhappy movers. What are some of the things that happy movers do have in common?

Todd Hargrove (all from here on unless noted are Todd): The point of the quote is that there are many more ways to do something the wrong way than the right way. If you watch novice runners running, you will see them doing a lot of idiosyncratic things- the way their foot is swinging, or their limbs are swinging- but if you watch elite athletes move, you will see much less variation in their movement.

In the book I identify 10 or 11 characteristics of good movement. Things like mobility, stability, posture, coordination, efficiency [and more]. But one of the things I can illustrate is distributing the work of movement which means many different joints in the body working together in an intelligent way. Handling the compressive stress every time you take a step- a really efficient runner would have all the joints sharing that stress. There is not one place that is taking all that work. It’s evenly distributed.

For example, if you are standing up and looking behind you- the ankles move a little bit, the hips move a little bit, you have 24 vertebrae that all rotate a little bit. All the different parts of the whole cooperate in that movement. But if some of the parts aren’t doing their job- sometimes you’ll see this as 4 or 5 vertebrae stuck and moving in a block- then other vertebrae are going to work harder. The essence of good movement is really harmonious coordination of all the parts

Brooke: You also say in your book that “Learning better movement is more like sculpture than like painting.”

The tricky part is to relax all the muscles you should relax, to get out of the way of yourself.  If you think about playing the piano, the hard thing is not hitting the key at the right time, the hard part is not hitting the key right next to it at the same time. It’s very easy for muscular activation to spread from one area to another.

So if you see novices fencing or doing a golf swing they are going to have a lot of unnecessary muscular tension. They move one area and other areas move at the same time. What characterizes really skilled movement is the ability to relax things, that’s why good movers always look easy, they don’t have a grimace on their faces, they don’t have this parasitic tension.

Brooke: You mentioned that marathon runners use 30% less energy than novice runners, and that people often train to “put a bigger engine in the car” [getting stronger, fitter, etc], when they really should just try to take their foot off the brake.” in this example would that be what you’re saying, learning how to relax this parasitic tension and take the foot off the brake? Or are there other ways to conceive of the tension too?

They are using their energy to move forward, and part of running training is getting stronger and increasing your power output. But another part should be getting out of your way- so each time you use your muscles to push yourself forward you are using all the muscles in your posterior chain. But if at the same time you are still contracting the hip flexors a bit, and you try to get the hip to go back, that will get in the way.

A skillful mover will be able to inhibit that unnecessary tension. So every time you contract a certain group of muscles to do a certain job, you are also relaxing the opposite group of muscles- it’s that coordinated teamwork.

Brooke: Posture- this can ruffle a lot of feathers in our fields, but a lot of studies are showing that differences in posture do not correlate to or predict differences in pain. (in resources)

Yes it is very surprising and it’s very counterintuitive to people like us who are working to get people  moving better and feeling better. We’ve directed a lot of attention to posture and looking at pain problems as being caused by bad posture, but there has been a lot of research looking at people’s posture and trying to correlate pain, and they don’t find those correlations there, so it’s really a wake up call to people who are putting excessive importance on static posture as something that causes pain and that we can fix to improve pain.

Brooke: Yet this doesn’t imply that posture doesn’t matter.

Yes we kind of throw out the baby with the bathwater sometimes. Posture is obviously very important for good function. Anytime you want to get something done in an efficient way, the alignment of your spine is going to be very important. If you want to do a heavy dead lift, or if you want to throw a baseball, or anything really. There is a great quote form a Russian physiologist Nikolai Bernstein  that I like, “trying to move with bad posture is like trying to write with a floppy pencil”. The orientation of the spine is the base from which our limbs move, and it matters.

It’s a pretty complicated question. I think you can predict injury [with posture]. If you do a dead lift with a rounded back you can predict that person is more likely to get injured. The world class spine biomechanist Stuart McGill says that about dead lifting. But if you look at someone’s static posture as they are standing, it is right to conclude that if you look at their posture you wouldn’t be able to predict if that person has pain.

Brooke: That brings us into motor control. Is there a nutshell version of what that means?

It’s the process by which your nervous system controls all your movements. You have all these different muscles and each muscle is broken down into different motor units and they can contract separately, and the nervous system can issue commands to contract these ones and relax those ones. You can think of it like you are a marionette with all these different joints that can move and all these different rubber bands that can move them- thousands and thousands and thousands of rubber bands- and there are strings attached to all of them. To move that marionette intelligently you would have to figure out what string to pull at what time, it’s an amazingly complex job that requires an amazing amount of information processing and intelligent decision making to get the job done.

There is a massive amount of unconscious brain power devoted to doing this. We have computers and robots that can beat chess champions, and win on Jeopardy, but we still haven’t built a robot that can do simple motor control things that  3 year old kid can do. We can’t build a robot that can walk over and load a dishwasher. Motor control is an amazing accomplishment of the brain. And we don’t really recognize how difficult it is because so much of it happens unconsciously.

Brooke: It’s amazing to think about how much of our brain is dedicated to movement. That our brain is really for us to move.

If our thoughts and emotions don’t end up in some sort of a movement- like walking to the store or reaching for a cup of coffee- then it’s all irrelevant it’s all wasted.

Brooke: You write about cortical maps, or body maps, and that the state of the map has big implications for how we feel.

The maps are part of the way we process information to get motor control done. We have discrete parts of the brain. A little part of the brain is devoted to gathering information from the body about what is going on in that part of the body, deciding what it means, and issuing commands to do something about it. So if I get touched on my hand, it activates sensory receptors and sends a message to the to the brain: “Something just happened down here, I just got touched on the hand.”, and the part of my brain with the map for my hand goes to work in figuring out what’s going on there and figuring out what to do about it.

The interesting things about these maps is that, for one thing, they are all different sizes depending on how much work needs to be done by the brain in figuring out what is going on in those body parts. So the map for my hands is huge, because my hands need to have this incredibly differentiated sense of perception. By contrast, the part of my brain that listens in on what is going on in my elbow is small, because it does not have major sensory demands.

If I’m a musician and I have to have a great awareness of where my fingers are and what they are doing, the map for my fingers and my hand will grow bigger in my brain. On the other hand if I really neglect moving in a certain way, my map will smudge, shrink, and not be as good at doing its job at sensing and moving that area precisely.

Brooke: There is a huge paradigm shift going on right now in understanding pain that takes into account these maps and motor control, but it’s also being explained quite a bit by the neuromatrix model.

The neuromatrix model is a way of explaining pain. It is simply the pattern of brain activity that gives the subjective experience of pain. Pain is an unpleasant conscious experience and it is designed to protect you against what the brain perceives as a threat to the body to motivate you to do something about it. Pain is an output of the brain- it is something the brain creates to warn you of the situation.

The reason I make that clear is that sometimes we get confused about pain and tissue damage. Tissue damage is damage in the body. It results in a sensory signal, a nociceptive signal coming from that damaged area. That’s not pain yet. The damage is just damage, and the signal is just a signal. It goes up into the brain and then the brain decides what to do about it. It’s not going to create pain unless it decides, “This is a dangerous situation, we need to create pain to protect us from that potentially dangerous situation.” It might decide, “I hear those nociceptive signals, but I don’t want to create pain right now because I don’t think that’s a good idea.” For example, if you were a soldier, and a toe got cut off, it would surely activate nociceptors in the foot and send a signal, but the brain might not create pain, because the pain might not promote your survival very well. The brain might think, “We’re not going to create pain because we need to run across this field and to get out of this emergency situation.” That’s why people often don’t feel pain in emergency situations.

On the other hand, there might be a relatively innocuous situation going on in the foot, and there is sensory information coming into the brain, and the brain for some reason interprets it as a very dangerous situation for the foot, and so can feel a lot of pain even though there is not a lot of tissue damage. That might be why tissue damage doesn’t correlate all that well with pain. It’s because the important decisions are being made in the brain by the neuromatrix.

The brain can be confused. Something happens in the body, the sensory organs report it, and it’s like a big game of telephone. The spinal cord receives that information from the body, it can suppress that signal, it can amplify that signal, it can misinterpret that signal as it goes to the brain. When you have a heart attack the problem is with the heart, but people often feel it in the left arm. It’s because the brain doesn’t really now what is going on, because it doesn’t usually receive signals from the heart.

Anytime you have referred pain there is this issue of miscommunication going on. And that’s why maybe the accuracy of the maps- their ability to accurately read what is going on in the body- is important for dealing with certain pain in the body.

Brooke: You describe it as “smudges” in body maps. That this can be a significant factor in contributing to chronic pain conditions.

It might be. People with chronic pain are found to have these smudges in their maps. You can see it on an MRI. The physical parts of their brain devoted to sensing different body parts, those delineations aren’t as clear. People in chronic pain don’t do as well on various tests of body awareness compared to people who have less pain. If you ask the person with chronic back pain to draw their back, they don’t draw the outline as well as people who have less pain. They locate the spine closer to the side that has pain. They don’t do as well on test of lumbo-pelvic control; They don’t have quote as good coordination. People in chronic pain, there is this connection between loss of body awareness and pain. That might be a two way street, we don’t know whether the pain is causing poor awareness, or the poor awareness is causing the pain. But it seems there is a dynamic relationship there.

Brooke: Some of the really interesting research you pointed out were researchers who found they can cause pain by creating sensory illusions.

The use of illusions is a way to trick your brain into perceiving something that is not there. One is the rubber hand illusion [resources] Here you put a rubber hand on a table right out in front where you can see it. You put if where your left hand would normally be, and your left hand is out of sight behind a screen. Your left hand gets tricked by the experimenter in a certain rhythm, while the rubber hand is stroked in an identical rhythm. So you are watching that rubber hand getting stroked at the same time you are feeling your actual hand getting stroked.

What this does is it fools the brain into taking ownership of that rubber hand. You get this visceral feeling that this hand belongs to you, and you’ll flinch when someone goes to hit that rubber hand.

What’s super interesting is that the hand that is out of sight, the brain disowns it. Less blood flow goes to it, it will suffer more inflammation. It’s almost like the brain is saying, “That’s not a part of our body anymore.” The takeaway here is that it’s important how the brain looks at your body.

Brooke: Hearing this it can maybe make us feel nervous, like we are at the whim of this strange dictator, and you write to think of the nervous system as an intelligent, overprotective mother.

But overprotective mothers can be kind of like dictators. One of its important priorities is keeping you alive. It doesn’t really care how you feel, it cares about keeping you alive to pass your genes along to the next generation. Sometimes overprotective mothers can be the same way. The care about you being safe, so they don’t let you go out and play. The nervous system, to protect you from yourself, it creates pain when it perceives that an activity is dangerous. It might make you stiff to keep you from going into what it perceives too much range of motion. It might make you tired to protect you against what it perceives as too much activity.

The idea is that part of the way we can improve ourselves is to convince that overprotective mother that what we’re doing is the safe thing to do. I think that’s what we’re doing when we do exercises in a safe, mindful, non-threatening way. You are sending good news to the nervous system. And it decides, ok, you can do that forward bend. It’s a lot of why bodywork works, and yoga works, is that you convince that overprotective mother to cut you some slack.

Brooke: A lot of your book is dedicated to Feldenkrais lessons.

Feldenkrais is a system for using these slow, gentle movements for more mindfulness and efficiency. Let’s say it’s not comfortable for you to reach your arm over your head. In a Feldenkrais lesson you can start doing the movement very slowly, really break it down and you repeat a small version of the movement enough times so that you are starting to chill out the nervous system and to show it that it is a safe thing to do. The hopeful result of the lesson if things go well is to gain subtle awareness about details that we might normally miss.

Brooke: On the opposite end of the spectrum, one of the ways people can reinforce negative maps is to push themselves through the pain.

You see that all the time in type A people who have a no-pain-no- gain attitude to the movement.  And to some extent that’s true- sometimes doing hard exercise can be a little bit unpleasant and you push yourself through that as a way to get your body to adapt and be more fit. But you can push yourself harder than your body can adapt as well, and you create a cycle of injury, and pain can be a habit. The more we create a certain kind of pain, we get better at creating that kind of pain.

Brooke: As a personal interest to me I found it fascinating when you talked about poor skill in motor inhibition and increased tendency to poor impulse control disorders like ADHD and even addiction. It’s an interesting bridge between movement and behavior.

The ability to inhibit unwanted movement is something we work with in Feldenkrais. You’re doing a very slow movement trying to inhibit unnecessary tension as you do the movement. Apparently, there is some correlation between inhibition like that and also inhibiting making of risky bets, or engaging in impulsive behavior.

One of the ways they can test that that is a stop task. You are looking at a computer and hitting a certain key every time something happens, but the next time something comes up on the screen and you have to inhibit yourself from continuing to hit that. The people who are better at inhibiting themselves from hitting that key are also better at inhibiting themselves from drinking too much.

I think there may even be a study [resources] that showed when people practice these stop tasks, and get better at this inhibiting themselves from unwanted motor responses they actually also decrease their tendency to engage in impulsive or compulsive behaviors. What the researchers had in mind is that our emotional skills in inhibiting unwanted behaviors and emotional responses is probably built on the same framework on which we are inhibit unwanted motor responses. So there might be a general skill there that is developed by motor control training. There have been a lot of traditions like yoga and martial arts where you are really training the mind and training your emotion by movement.

Brooke: I would love to see the world showing that bridge more and more- that training in good movement patterns will help them with these other issues.

Brooke: One other thing you point out is about play, that children in general don’t learn fundamental movement patterns through work, or through instructions.

It’s interesting to look at the way kids develop their motor skills. Within 2 years they go from a quivering blob on the floor that can’t do anything to someone that can walk across the floor and perform thee amazing feats of motor control. There’s something to be learned by how that development takes place. It doesn’t happen by a coach telling a kid exactly what to do. It happens by a kid following their own interest and doing what they want to do. They actually learn extremely fast. I think there is something we can learn from that as we try to do anything better;  Having an attitude that is playful, exploratory, and curious. If you want to get better at tennis you are going to have a coach, but it’s also important to go out there and explore things in ways that are interesting to you and to do your own thing. You can bring that to any practice.

Home play!

I read through a very abbreviated version of one of Todd’s Feldenkrais lessons in his book, A Guide to Better Movement. The book has many lessons for improving your motor control and your cortical maps. This particular one that I go through in the podcast is flexion/extension patterns in quadruped.

Resources

Todd Hargrove’s site, www.bettermovement.org

Todd Hargrove’s book, A Guide to Better Movement

On posture not correlating with pain: Christensen, Hartvigsen “Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health.”

The rubber hand illusion increases histamine reactivity in the real arm: Barnsley et al.

The Feldenkrais Method

Studies on motor control and inhibition of risky behavior or impulse control: Spierer et al, “Training-induced behavioral and brain plasticity in inhibitory control, and Verbruggen et al “Proactive motor control reduces monetary risk taking in gambling”

If you liked this episode

You might like:

Steve Haines: Body Maps and Interoception

Bo Forbes: Mindfulness Expressed in the Body

David Weinstock: Neurokinetic Therapy and Motor Control Theory

Constance Clare-Newman: Alexander Technique

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