My co-worker was on vacation recently and I was seeing one of his chronic pain patients (years of pain). She was doing very well and was becoming independent in a full exercise routine. I did a quick evaluation and noticed one thing that she could improve on from a movement perspective. I didn’t use any dangerous pathoanatomical language. I just simply pointed out that she could be stronger if she kept her rib cage down when she performed certain exercises. We went over this cue a bit more with some basic proprioceptive exercises before she started her exercise program.
About 20 minutes into her routine, she stopped and approached me. I was worried she was going to complain of pain or be confused about the “ribs down” cue. But instead she said with a smile, “you know, it’s nice to think about something other than my pain for once when I exercise”.
As a physical therapist who works with people who have pain with simple movements, this was quite profound.
I have been hearing from many professionals that external cues are far superior to internal cues. Some people even go as far as saying you should never use internal cues. However, this all or none approach doesn’t seem to be the case in the clinic. With this specific client, internal cues were beneficial on a few different levels. So I wanted to dig in a little deeper and look at cueing from a different perspective. I did some research and will summarize my findings in this series.
Keep in mind this is from a physical therapist’s point of view. The world of sports performance is always a hot topic. The exciting things people are doing with professional athletes are always interesting and fun to integrate into rehab. But what works for the NBA’s Lebron doesn’t always work for the AARP’s Betty. Not everyone lives their life to improve their sports performance. So keep in mind:
- Performance Training is a Luxury. Movement Training is a Necessity.
Yes, this patient has been educated on pain science thoroughly, she has read books, watched videos, and has seen a psychologist for her chronic pain. This post series will be focused on coaching and cues used for improving movement. For more information regarding pain, I highly recommend starting with Adriaan Louw’s work and ISPI.