I am wondering... Have you ever thought about skin stretch as an alarm signal for the nervous system?

Well this week, one of my patients got me thinking about it when they were saying things like this in our session...

• "I feel it pulling in my low back when I do that"
• "When I sit, I can just feel this tension back there"
• And so many other statements about this "pulling" sensation that seemed more than a mobility issue

They have persistent low back pain, and it was clear that this particular sensation was a "bad" thing that they had to avoid -- So we explored it.

I asked, "So when you feel that pulling sensation... what does that indicate to you? What is significant about that?"

They replied, "It's what I feel when something potentially might go wrong."

It made me really curious -- Is this a sensory signal from their tissues that their brain was using to predict what is and is NOT safe to do with their back?

"That's really interesting... do you think something like a skin stretch would be provoking?" I asked.

The person felt strongly -- "No, that's nothing."

Ok well, let me tell you... it wasn't nothing, it was something incredibly fascinating.

For this person, forward bending was a trigger for pain symptoms and guarding.

So we decided to try imagined movement and... we added a sensory twist -- a self skin stretch.

• In standing, they applied a downward stretch to their skin over the area that was "the problem".
• They reminded themselves that it was just a stretch they felt.
• Then they imagined that they were bending down.
• They wanted add a little movement -- so they chose to flex at the hips ever so slightly (I'm talking hardly any movement).

And guess what?

They opened their eyes and said, "Whoa, it feels like I am bending so far forward that I could touch the ground, but I'm hardly moving my back at all."

Clearly.... their sensory feedback mechanism and perception was off.

Ok, but it gets even better -- After they did several more rounds of imagined movement + skin stretch, they could bend down further with less guarding and less discomfort.

What is so cool about this is that their brain learned (in a very safe and controlled context) that those stretch sensations do not need to be alarming, which allowed this person to move more freely and less protected.

Now let's add a little splash of reality to this scenario:

• Did we "fix" this problem in one session? Nope, but we challenged that prediction which is a great start!
• For this person in particular, there is A LOT of unwiring to do when it comes to predictions -- so we are going to need lots of practice AND in different contexts.

Ok, now if you are wondering how I knew how to "hack" this person's nervous system, you have to read this article (hit that pink button below).

It is a MUST read to understand WHY people end up in this cycle AND it provides a framework to get you started that is a little more structured than some of the creative, functional twists on these concepts that I have been sharing with you.

Ultimately, the best way to make an impact is by understanding how the neuroscience works and by listening closely to your patients for clues in how to unlock their abilities.

Check out this super awesome article from some of my favorite authors👇 Fit for purpose article

Have a great week,

Brittany Kim 🔥 the CRPS PT ​ PS. Just wanted to make sure you knew about this because it is the last week you can sign up for it -- If you were looking for an in person con-ed course on the spine in L.A. (2.9 CEUs), I am one of the instructors for USC's Spine Rehabilitation Series this week (Module 2). I am teaching on clinical applications of pain neuroscience. Maybe I'll see you there!