Deliberate practice and pain

We all do it – clinicians, clients, athletes, and workers – we go through the motions. We move from one activity to the next with very little focus or purpose in our actions. To enhance performance or the healing process, we ought to do more.

For many years we have understood that deliberate practice can exceed results of just “practicing”. We have learnt that a greater awareness in one’s body can modify the pain experience. As a physio, dealing with both pain and performance, deliberate practice and awareness are powerful tools.

Neuroplastic training is term used to describe exercise with either an internal or external focus. The description can be misleading because to some degree all exercise is neuroplastic. Any movement or practice has the ability to impart change on the nervous system. The extent of the neurological change can differ depending on how we practice. I see neuroplastic training as a form of deliberate practice or practice with awareness.

Certain forms of exercise harness these tools better than others. Pilates and yoga encourage both deliberate practice and body awareness. Traditionally it is has been the movements within these practices that are sold as the benefit but it is my belief that they harness the brain better than other forms of exercise. I encourage patients to stick with their chosen exercise passion but to take heed of the lessons we learn from pilates and yoga. It is not enough to simply do your sport and to allow your mind to wander. I want the activity to have purpose and for patients to be aware of their sensory surroundings.

When I began my career I was introduced to the meaningful task analysis. The assessment was performed on the most salient task. If shooting a hockey puck hurt, it was assessed; if it was a golf swing or a portion of a stride, those tasks. The chosen therapeutic exercise then followed the same paradigm. If the exercise was not salient from the start, the client was encouraged to visualize the movement. Patients were to perform less repetitions but with more purpose and greater frequency throughout the day. This form of deliberate practice allowed pain to be un-coupled from an associated movement.

In addition to deliberate practice increasing body awareness during exercise can be very effective at changing the pain experience. Greater awareness can come in many different forms. You can be aware of the breath, the painful area, non-painful areas, external cues, or new sensations. You can also set goals for the exercise and gradually make it more challenging. The aim is for new inputs to compete with incoming nociception (danger signals). These practices start to redefine borders in the homonculus and enhance the “unlearning” process of a pain response. The end result is less pain.

I prescribe to a bio-psychosocial model of care. By being deliberate in our practice and aware of our sensations we start to recognize the mind and body as one. Next time you are practicing or working through pain try harnessing the tools discussed in this post.