We were honored to have Ben Geierman (@medicinal_movement_rx) attend our PSMMT November course and also spend a day observing the application of the course materials in our clinic at Dynamic Movement and Recovery. Ben has taken a number of courses over the years and has really good insight into the global picture of the Biopsychosocial model across the recovery and training paradigm. He was kind enough to write up his experience of the weekend as well as how it was applied in the clinic. We offer this opportunity to any of our course attendees and we believe it gives the most insight to see the content in action. Without further ado, here were Ben’s thoughts:

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This past weekend I had the unique opportunity to not only take Dynamic Principles Pain Science, Movement, & Manual Therapy (PSMMT) course but also to spend the following day with Leonard & David experiencing first hand how they incorporate the principles taught in the course into the everyday application of treating those in pain.

Overall, the course was a great overview of the current evidence on everything pain, manual therapy, neurodynamics, contextual factors, and critical thinking. However, I found myself most intrigued by the lab component and ‘movement experiments’, particularly with walking and standing.  Initially, these movement experiments seemed quite peculiar as I walked back and forth across the clinic, being mindful of the feelings in my feet, ankles, knees, hips, spine, and so forth all the way up to the head. We performed a similar experiment in standing, playing with various stances and positions at each joint to try to find the greatest position of ease. These were very interesting experiments and quite novel to me, however, I wasn’t quite sure how I would implement them in the clinic or honestly if I could even get patients to take them seriously. However, those concerns were quickly resolved as I spent the next day with Leonard and David watching them put these experiments into action.

Both Leonard and David used the movement experiments quite often during treatment sessions and I was surprised to see how well patients responded to them. Most of the patients we saw that day had persistent pain and previous therapy consisting of more structural interventions and passive modalities without much relief. However, the movement experiment approach was much different and allowed the patients to actively explore their experiences. One patient’s experience in particular stuck with me. She was having hip pain and felt it every time she stood up. By leading her through a movement experiment and some mental visualization techniques, she was able to subtly alter the way she moved all by herself and stand up pain free in less than 5 minutes. Another patient with low back pain participated in a walking experiment and was able to become more mindful of her movement and find a way to decrease her symptoms through finding the movement pattern that provided the most ease. Now most of these patients still had symptoms, but by utilizing these movement experiments, they were able to be more mindful of their movement, experience their symptoms, and discover a new way to move in order to “create space” within their experience to allow for more movement freedom and decreased suffering.

The magic of these experiments further solidified their usefulness as I found myself at the gym in the following days. I had personally been working through some knee pain for the past few weeks while simultaneously completing my powerlifting programming in an attempt to increase the strength of my squat. This was beginning to become quite a frustrating experience, as my knee pain would consistently increase in severity as I added weight to the bar, causing me to have to decrease the weight on the bar during my top sets and subsequently cease the progress I had been making before the knee pain arose. However, after spending the weekend at the PSMMT course, I decided to run a little movement experiment myself. By playing with my stance, squat depth, and bar position, I was quickly able to discover a squat pattern that allowed me to squat without symptoms and even work up to my programmed weights on my top sets essentially symptom free.

Now I pride myself on being a ‘movement optimist’ and finding ways to modify painful movements temporarily while sensitivity decreases, but even in light of that, the pain I experienced in my knee over the past weeks and the associated frustration that came along with the inability to progress my strength as planned, narrowed my perspective to the point where I found myself in a repeating loop of pain and frustration.  This essentially incarnated from coming into the gym feeling fairly well, working up to a decent weight, and like clockwork, experiencing a return of pain in my knee pain again. This experience, as I believe is common with many pain experiences and supported the movement variability research, led to me to pigeonholing my options with various squatting techniques due to my hyper vigilance and yearning to perform the movement as usual without any pain. I think this is such a common occurrence with folks dealing with pain, especially persistent pain, where we get stuck in a rut of doing things the same way over and over again without noticing and continually experiencing the same symptoms, creating a vicious cycle or pain that further fuels itself. However, the beauty of the movement experiments is to allow you to find alternative options on your own to break this cycle by improving your relationship and awareness with your body and movement, all while increasing autonomy and self-efficacy by managing symptoms independently.

Overall, this course was a game changer for me and getting to experience first hand how the material was implemented in the clinic was invaluable. Although I took the most from the movement experiments, there were a ton of other gems in the course and nuggets on new research that I had not been aware of and which will certainly positively affect my future practice. Nonetheless, the magic of the movement experiments will stick with me most, and I loved the acceptance and commitment therapy (ACT) framework presented alongside it for working with people dealing with persistent pain. The whole approach is essentially aimed at accepting the symptoms but committing to engage in meaningful activities despite, in order to decrease suffering and improve function. However, it’s imperative to recognize that acceptance does not mean passivity and by using the movement experiments, patients are able to actively create space by becoming more mindful of their movement, leading to greater flexibility to live meaningfully in spite of pain. I firmly believe this approach will be immensely helpful for my future patients dealing with persistent pain and I highly recommend experiencing Dynamic Principles course first hand for any healthcare provider treating humans in pain.

Ben Geierman DPT, CSCS

Your client is here.

You, at a normal pace, hurry to greet them but quickly slow in approach as you watch them rise from their seat with the movement quality of someone 50 years their senior.

The slow rise finishes with qualities of an old machine attempting to shift into a locked position as they intensely brace themselves through the maximal slow strenuous effort to extend their hips and spine to an upright posture.

You start your steps toward the treatment room but by your second step you realize you already passed your client 6 feet ago. You realize, it’s time to be here now.

The journey to your treatment room provides time to review testing findings and discussions both you and the client’s had coordinated with other disciplines. The patients words require significant effort for them to express.

Their words have a defeated and tired air to them but they certainly are giving all their effort.

The travels, the demands of work and the significant struggles in family life, the sheer tenacity and will to keep going in spite of a body that screams for rest. Life must go on after all does it not?

You observe the posturing that looks that of a much frailer representation of the younger client who stand before you. Your mind wants to speak of the antalgic changes in kinetic loading from foot to head and the way the sandals are worn on the feet to allow for some relief but now is not the time. The rigid shoulder and arm posturing, the clenching of the fists, and the strain of the words coming from their mouth.

You arrive at your treatment room, you lower the table. Already all plans for the session have changed four times since you first greeted your client.

Every plan shift reviewed systems, symptoms, behavior, client report, reconsideration of other discipline objectives, the social and work constraints presented by the client. Where is my entry point today, no not there, ah there, no the time is not right, could they progress on that from before, are they ready for this? No not now, let them lead.

You place the chair but the client opts for the table.  They do not know their body, they do not know struggle they themselves are adding the problem, but words do not matter now. Only the bolster and hands on guidance for ease.

The client exhales a sigh of relief for a moment, their eyes change as they seem to indicate that they just learned something in that process, and they thank you for helping them.

You notice the swelling of both ankles are improved since the last session and the client reports they are seeing improvements since the first session with the strategies you had discussed.

You know the relief is short lived and begin planning in the background the next steps and how those steps could be used to further educate and empower the patient to learn know their own needs better. You balance your words in your mind as you find ways to both the dance with the complexity of, dare I label and define it?

Moments later the next wave has arrived and stuns the client into a heightened state once again. They steel themselves and demonstrate an intensive muscular effort of the back and hips that they report provides them momentary relief of both legs but worsens their back.

The session now reveals itself dynamically.

The dance of the dialog and interactions of session now reaches a flow point. You and your client work together to engage the suffering and workability of their struggle with pain.

The dance is certainly technical, from review and progressing of  meaningful understanding and application of the physiology, the cognitive, the emotion, and the social interactions.. To managing the biomechanical outputs through hands on guidance and coaching of positioning relief  to allow them to appreciate value of awareness and exploration of the automatic postural and guarding response of the human body. The larger picture unfolds and the conversation naturally leads to where the client is going to engage in the process.  The artistic beauty of the interaction paints the picture, rather than the technical details.

The client breaths comfortably. The pain is less, but this not important. What is important is that the meaning of the pain has changed. They feel hopeful and they know their role in the process going forward.

The time allotted is now over. Now the journey from the sterility, but subtle safety, of the room to the clients own reality begins. They arise now taller, there is a lightness present in their movement, and there is strength in their words.