"The Benefits of Pacing and Movements" by Katherine Lyttle PT, DPT

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"The Benefits of Pacing and Movements" by Katherine Lyttle PT, DPT was presented at the 12th annual Cheri Woo Scleroderma Education Seminar on March 9, 2013 hosted by Oregon Chapter of the Scleroderma …

"The Benefits of Pacing and Movements" by Katherine Lyttle PT, DPT was presented at the 12th annual Cheri Woo Scleroderma Education Seminar on March 9, 2013 hosted by Oregon Chapter of the Scleroderma Foundation.

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  • 1. The Benefits of Pacing and Movement Katie Lyttle PT, DPT March 2013
  • 2. Your body’s response to painPain makes you want to move differently and/or less – This is normal – Motor changes are a response/output to a perceived threat – Protective response  Movement is protective and helpful in the short term BUT problematic in the long term
  • 3. How do you start moving?• Understand the benefits of moving 1. How inactivity affects the tissue 2. How the tissues will specifically benefit from movement• Finding your baseline for various activities• Doing enough but not too much, or too little• Log activity/movement• Progressing activities• Flare up plan Continue to assess barriers throughout the whole
  • 4. Activity IS important• Our bodies rely on movement to maintain overall health• Without normal movement tissue becomes unhealthy and body systems do not function properly•  movement = unhealthy tissue – Does unhealthy tissue feel good OR bad? – For many  pain means  activity = unhealthy tissue
  • 5. Activity IS important Our bodies are DYNAMIC– Body systems and tissue are continuously changing according to the demands placed on it, positive or negative • Wolf’s Law: form follows function • Use it OR lose it– We do not have the option to do nothing and stay the same– Everyday what we choose to do or not do causes a change that could be positive or negative
  • 6. What happens to the body with inactivityMusculoskeletal system• Muscle atrophy  muscle fatigue and decreased endurance(1)• Altered neurologic control of muscles – The body “forgets” how to coordinate muscles(1)• Decreased joint stability(1) – Increased risk of injury• Muscle length imbalance around joints(1) – Short and tight vs. long and weak
  • 7. What happens to the body with inactivityNervous system• Decreased Nerve mobility(6) – Decreased oxygen delivery to nerves(3,5) – Increased nerve sensitivity  decreased pain threshold• Altered sensory perception(3)• Increased inability to cope with stressors(2)• Increased susceptibility to depression(2,3)
  • 8. Benefits of movement• Increased blood flow(6,7) – Healthier tissue: muscle, tendon, nerve, bone, etc.• Increased muscle strength – Improved endurance and activity tolerance – Improved joint support• Restoration of tissue balance – Lengthen what is short; strengthen what is long and weak• Decreased stiffness; increased range of motion – Motion is Lotion
  • 9. Benefits of movement• Decreased nerve sensitivity(6,7) – Normalization of pain threshold• Improved sleep – Improved balance between sympathetic nervous system and parasympathetic nervous system • Parasympathetic = “rest and digest” • Sympathetic = “fight or flight”• Improved emotional and stress management• Activation of the release of endorphins
  • 10. Bottom Line•If you don’t move, your pain can increase, even in healthy tissue•Maximizing motion/function is critical for all joints and tissue•Exercise interrupts the chronic pain cycle •Avoiding motion causes more long term problems
  • 11. Why is pacing important?• Prevent pain flares• Prevent “boom/bust” activity  increased pain – Extreme bouts of activity followed by an extended recovery period• Maximize function; increase function• Minimize recurrent injury• Respect rest/activity balance
  • 12. How do you start moving?• Understand the benefits of moving• Find your baseline for various activities 1. Have to start somewhere to get anywhere• Do enough but not too much, or too little• Log activity/movement progress at a week at a time• Progress activities• Flare up plan Continue to assess barriers throughout the whole
  • 13. What is your baseline?What you CAN do currently without makingyourself worse?Amount that you CAN do…• without overall making yourself worse the rest of the day• In a day and and not feel worse the next day• Each day without needing a full day or more
  • 14. Find your baseline1. Take BASELINE pain level2. How much activity can you do before your pain increases?3. If your pain level increases, does it return to your baseline when you stop the activity? • YES; that is a good amount to start with and that is your baseline • NO; that is likely too much activity and you need to start with less.4. If you want to be conservative: STOP the activity BEFORE your pain stops you = your baseline
  • 15. How do you start moving?• Understand the benefits of moving• Find your baseline for various activities• Do enough but not too much, or too little – Boom bust vs. just in case• Log activity/movement• Progress activities• Flare up plan Continue to assess barriers throughout the whole process.
  • 16. Beginning and Progressing Activity
  • 17. How do you start moving?• Understand the benefits of moving• Find your baseline for various activities• Do enough but not too much, or too little• Log activity/movement – progress at a week at a time• Progress activities• Flare up plan Continue to assess barriers throughout the whole process.
  • 18. Log, keep track of activityAllows you to…• Manage flares more accurately – Identify cause of the flare – Change activity accordingly if a flare occurred• See your progress – Motivation• How – Calendars – Online exercise/activity journals – Grids – Apps?
  • 19. How do you start moving?• Understand the benefits of moving• Find your baseline for various activities• Do enough but not too much, or too little• Log activity/movement• Progress activities – Progress by an amount you KNOW you can successfully do.• Flare up plan Continue to assess barriers throughout the whole
  • 20. How to progress your activity• Increase a small amount every week or two• Progressions should be easy and attainable – Increase in baby steps – *Small increases you know you can successfully do*• If you flare up after you progress your activity, you increased too much, too soon• Keep progressing!• You should always be progressing until you reach your goal
  • 21. How do you start moving?• Understand the benefits of moving• Find your baseline for various activities• Do enough but not too much, or too little• Log activity/movement• Progress activities• Flare up plan Continue to assess barriers throughout the whole process.
  • 22. Flare-up PlanIs it realistic to think that you will NEVER have a set-back?1. Do not PANIC – Use heat, ice, movement, reasonable rest periods, TENS, relaxation to decrease the flare2. Keep track of what triggered your set-back – Use the information to prevent the same flare from happening again3. Maybe decrease your level of activity in order to preventfurther exacerbation – Prioritize your responsibilities – Say NO to unnecessary demands until you’re function is back at your before flare baseline – Ask for help4. Don’t stop all activity, KEEP MOVING
  • 23. How do you start moving?• Understand the benefits of moving• Find your baseline for various activities• Do enough but not too much, or too little• Log activity/movement• Progress activities• Flare up plan Continue to assess barriers throughout the whole process.
  • 24. Barriers: what keeps you from moving forward• Ambivalence to change – Interested in change, but not ready to commit – Cost vs. benefit – 30 days of rehearsed behavior change takes another 3 months of practice to stick.• Priorities – Daily, weekly, long term• Boundaries – Expectations from others and self – If I change, others (family, children, friends) may have to as well
  • 25. Barriers: what keeps you from moving forward• Values o What do you care about most? o What are your basic assumptions about what makes you a good person, life worth living? o How do you define your self-worth? o Most people discover some values/assumptions that can sabotage their recovery efforts. o If you feel stuck in your progress, it may be connected to a deeply-held value that is interfering with progress.
  • 26. ReferencesReferences:1. Knight J, Jones A, Nigam Y. Effects of bedrest 3: musculoskeletal and immune systems, skin and self-perception. Nursing Times. 2009; 105: 23,18-22.2. Nicholas M, Molloy A, Tonkin L, Beeston L. Using Pacing to Overcome the Effects of Chronic Pain on Activities. Practical and Positive Ways of Adapting to Chronic Pain, Manage Your Pain. London: Souvenir Press Ltd; 2003: Chapter 7.3. Knight J, Jones A, Nigam Y. Effects of bedrest 2: gastrointestinal, endocrine, renal, reproductive and nervous systems. Nursing Times. 2009; 105: 22,24-27.4. Knight J, Jones A, Nigam Y. Effects of bedrest 1: cardiovascular, respiratory and haematological systems. Nursing Times. 2009; 105: 21,16- 20.5. Butler D, Moseley L. Explain Pain. Australia: Noigroup; 2003.6. Butler D, The NOI Team. Mobilization of the Nervous System Course. Neuro Orthopaedic Institute (Australia). 20th Edition. January 2010 – USA 2 day.7. Butler D, Moseley L. Explain Pain Course. Neuro Orthopaedic Institute 2009.8. The McKenzie Institute USA. Mechanical Diagnosis & Therapy: The