When it comes to musculoskeletal conditions there is often a large aspect of rehabilitation which is overlooked, thus being a reason for persistent pain. This is known as neuromuscular control, a complex term which involves the control of muscles through an intricate network in the brain.
In order to overcome this it is important to understand how the brain responds to pain, and how neuromuscular control, or rather the lack of it, impacts pain development.
A simple way to understand the brain’s adaptations as a response to pain is through the analogy of producing a car. Prior to starting, naturally the process is planned and organised; everyone is given their roles depending on expertise. Now, if the painter should feel unwell and not be able to perform his role to the best of his ability, the production does not come to a standstill. It is now up to the welder who has a little experience with painting to fulfil that role, thus relying on the engine forger to assist with welding. Each role is now compromised in quality and the process is disrupted
Now, similarly if an injury exists in one area of the body, it will not result in a full shutdown but instead the brain will switch on numerous compensatory responses in other areas of the body in order to prevent that. So muscles are now forced to operate in a way that is not normal for them, although they are temporarily able to fulfil the role it is compromising the quality of their function.
As these compensations continue, muscles will lose their ability to activate at the correct time or at the correct intensity (poor neuromuscular control). Hence, a lack of neuromuscular control develops; this causes the brains pathways that control movement to become impaired. These compensating muscles allow joints to become poorly controlled, which becomes increasingly painful.
Let’s take lifting as an example, muscles will first start activating around the foot and ankle to stabilise the feet on the ground, then the thigh muscles will start firing to stabilise the knees followed by the pelvis and the back. If the thigh muscles do not switch on at the correct time, this synchronised pattern breaks down so the knee joint is not supported in the most effective way, and the vicious cycle of pain may potentially ensue. This is likely to happen in the presence of an acute meniscal tear, for example. In order to protect the joint the brain will force the hamstrings (muscles behind the thigh) to brace in a shortened position, the longer they continue to do this the weaker the quadriceps (muscles at the front of the thigh) will become. Resulting in poorly controlled knee joint which is more prone to injury.
In order to manage pain, and improve function, it is vital to overcome the compensations that have developed.
At AposHealth® we aim to do exactly that. When pain is present it is very difficult to perform your normal day to day tasks, be that walking, standing to cook or running. Whilst wearing the personalised AposHealth® biomechanical device, the finely tuned position of the pods on the sole and the mild controllable instability allows us to bring the body to optimal functional alignment and to offload painful areas. Performing normal day to day activities provides the thousands of repetitions required to retrain the brain. This motor learning that is taking place is a result of the mild instability provided by the convex pods, as it forces the brain to take corrective measures to ensure the joint is stable. As the muscles gradually start functioning correctly, the joints become more stable, better controlled, and pain will also reduce. Completing day to day activities while wearing theAposHealth® foot-worn device allows the brain to receive correct sensory feedback, so it is better able to plan and execute movements. Over time the impairment in neuromuscular control that previously developed will start to be repaired and the muscles will return to operating in their designated roles, (i.e. the painter recovers so the welder and forger can return to their normal roles) therefore allowing you to gradually return to your normal activities with reduced pain.
Hopefully to begin with, this will give you an insight into how pain mechanisms of the body can become persistent and how AposHealth® can overcome this. In my next blog post I will delve a little deeper into the workings of the brain when pain is present.