4 / 2 2 / 2 0 2 0 Activity Basics Week 1 of 4 1 CALGARY FOOTHILLS 1 Agenda for Week 1 • Virtual Housekeeping • Review of Explain Pain • Self-monitoring • Rest and Activity • Stretches • Approaches to Activity CALGARY FOOTHILLS 2
4 / 2 2 / 2 0 2 0 Virtual Housekeeping • Presentation slides • Weekly handouts • Using the chat box to ask questions 2 • Opportunities for group discussion • Technical issues CALGARY FOOTHILLS 3 Chronic Pain EXPLAIN PAIN REVIEW CALGARY FOOTHILLS 4
4 / 2 2 / 2 0 2 0 Explain Pain • We feel pain in the body, and the brain decides how much pain based on: - Sensory information from the body - Thoughts, emotions, memories - Awareness of the environment 3 • The degree of pain felt ≠ amount of damage in the body • The more often the alarm bell rings, the less stimulus needed before the brain perceives an activity or situation as dangerous and triggers pain CALGARY FOOTHILLS 5 Physical Self-Management Strategies Self-management strategies • Positioning in bed • Pacing facilitate improved posture • Neutral body mechanics • Increasing physical and physical fitness, positive tolerances • Heat/cold thoughts and emotions, and • Ergonomics • TENS efficient interactions with • Taking medication as • Aerobic exercise the environment, which prescribed result in the brain giving a • Strengthening • Flare-up planning and stretching exercise person less pain CALGARY FOOTHILLS 6
4 / 2 2 / 2 0 2 0 4 Self-Monitoring CALGARY FOOTHILLS 7 Increasing Self-Awareness • Insight is the KEY! Pain diary, lifestyle journaling, activity logs • Helps identify factors that contribute to pain level – Factors within your control: i.e. Positive self-talk, duration/intensity of a task, using coping skills – Factors outside of your control: i.e. weather, family emergencies • Helps you to notice your responses to situations – Automatic thoughts, holding your breath, uncontrolled worry, isolation CALGARY FOOTHILLS 8
4 / 2 2 / 2 0 2 0 Take Back Control • Awareness of the relationship between thoughts, emotions, activities and pain 5 • Testing new approaches to self management and getting things done • Empowering yourself to improve functioning and reduce pain CALGARY FOOTHILLS 9 Self-Monitoring Log • Choose 3 times each day to consistently note your pain and/or fatigue level (__/10) • Record your activities (and rest) throughout the day – Pay special attention to anything different/new (e.g. groceries, medical appt’s, new coping skill) • Make note of potential triggers (e.g. weather, family visiting from out of town, emergency situations) • Record your overall mood for the day (__/10) • Comment on or rate your sleep from the night before (__/10) CALGARY FOOTHILLS 10
4 / 2 2 / 2 0 2 0 6 Rest and Activity CALGARY FOOTHILLS 11 PAIN FUNCTION 12 CALGARY FOOTHILLS 12
4 / 2 2 / 2 0 2 0 The Cycle Of Inactivity Pain Guarding Anger/Depression/Anxiety 7 Muscle/Joint Stiffness Reduced social activities Loss of function Reduced mobility Weakness CALGARY FOOTHILLS 13 Injury, Pain & Rest • Rest and Acute Injury – Typical response to pain is to stop the activity that causes pain – In new injuries a relatively short period of rest is appropriate • Rest and Chronic Pain – When pain becomes chronic (past the normal time to heal), rest may decrease the pain, but the relief is only temporary – Too much rest can lead to the cycle of inactivity CALGARY FOOTHILLS 14
4 / 2 2 / 2 0 2 0 Chronic Pain & Activity • Research tells us that activity and exercise are helpful in the overall management of chronic pain and fatigue 8 • However, changing or increasing physical demands on the body can increase pain and fatigue • Many people with chronic pain have been told to be active, but have never been instructed on how to start CALGARY FOOTHILLS 15 Activity Tolerance • How much of an activity a person can do before they experience a noticeable increase in pain or fatigue • How much of an activity a person can do before they feel that if they continue they will experience a delayed increase in pain or fatigue CALGARY FOOTHILLS 16
4 / 2 2 / 2 0 2 0 9 Stretches CALGARY FOOTHILLS 17 Stretching • Gentle stretching helps to relieve muscle tightness and increase range of motion • Can be done daily (start with 3X/week and gradually increase) • Stretch until you feel a gentle pull • Hold go 5-15 seconds to start, increasing duration as tolerated CALGARY FOOTHILLS 18
4 / 2 2 / 2 0 2 0 Hamstring Stretch • Sitting with one leg extended, ankle flexed • Lean forward at hip (keep neutral 1 0 spine) CALGARY FOOTHILLS 19 Hip Stretch • Sitting position, cross one ankle across your knee • Sit up tall • To increase stretch, lean forward slightly at hips CALGARY FOOTHILLS 20
4 / 2 2 / 2 0 2 0 Back Stretch • Sitting position • Interlace fingers and reach forward 1 1 • Alternatively, sitting at a table rest your arms on the surface and reach forward CALGARY FOOTHILLS 21 Chest Stretch • Rest forearm on wall • Step forward keeping neutral spine CALGARY FOOTHILLS 22
4 / 2 2 / 2 0 2 0 1 2 Approaches to Activity CALGARY FOOTHILLS 23 'Do It No Matter What' Approach To Activity • Do as much as possible despite the pain • Stop only when the task in completed • Push through the pain • "This has to be done" "I've always done it this way" CALGARY FOOTHILLS 24
4 / 2 2 / 2 0 2 0 'Do It No Matter What' and Function • Pushing through pain rarely leads to improved function • Overdoing it on good days leads to higher levels of pain on 1 3 bad days • Over time there are fewer good days, more bad days, and overall function is lower CALGARY FOOTHILLS 25 'Do It No Matter What' and Activity Tolerance Activity Level Tolerance - pre Do it no matter what Tolerance - post Time CALGARY FOOTHILLS 26
4 / 2 2 / 2 0 2 0 The 'Wait Until' Approach to Activity • Rest and wait until pain decreases before doing an activity • Avoid activities that cause pain 1 4 • "If I do this, it's going to hurt!" CALGARY FOOTHILLS 27 'Wait Until' and Function • Overly cautious good days decreased physical conditioning, therefore activity hurts more than before • Higher levels of pain due to inactivity on bad days • Over time there are fewer good days, more bad days, and overall functioning is lower CALGARY FOOTHILLS 28
4 / 2 2 / 2 0 2 0 'Wait Until' and Activity Tolerance Activity Level Tolerance 1 1 5 Wait until Approach Time CALGARY FOOTHILLS 29 Comparing Approaches Do it no matter what Activity Level Tolerance - pre Wait until Tolerance - post Time CALGARY FOOTHILLS 30
4 / 2 2 / 2 0 2 0 Combination Approach • 'Wait until' approach towards non-essential or unpleasant activities 1 6 • 'Do it no matter' what approach towards essential or priority activities • Inability to improve overall function and reduce pain on a consistent basis CALGARY FOOTHILLS 31 An Alternative Approach: Pacing • Create a balance between activities including self care, productive and leisure activities • Complete priority tasks more efficiently, without significant increases in pain or fatigue •Schedule activities, rest and coping strategies to have a more equal output of energy from day to day •Increase tolerances for specific activities over time CALGARY FOOTHILLS 32
4 / 2 2 / 2 0 2 0 Tolerance - post 1 7 Tolerance - pre CALGARY FOOTHILLS 33 Group Discussion: What is your typical activity approach now? Have you tried the Pacing approach? How might changing your approach be challenging? How might Pacing help you manage your pain/fatigue? CALGARY FOOTHILLS 34
4 / 2 2 / 2 0 2 0 Thoughts that Support Pacing • "If I pace myself, I'll have energy to enjoy my family later." • "I can start it now, and finish it this afternoon." 1 8 • "When others think of me they think about my personal qualities, not about how much I get done in a day." • "I have prioritized my activities, so by sticking to my plan I'll be getting the most important things done." CALGARY FOOTHILLS 35 Homework • Self-monitoring – Pay attention to the relationship between your activities, mood, sleep and pain/fatigue – Notice how you approach your daily activities • Exercises • Stretches CALGARY FOOTHILLS 36
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