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The REAL Truth About Pain Science and Body Mechanics: A Response to Criticism

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Pain can be a complex phenomenon, meaning that many different factors might contribute to pain, and that these factors can be interwoven in a way that makes it very hard to separate one from the other, either for purposes of explaining pain or intervening to treat it in some way.

This was the theme of a talk I did a few weeks ago at the Oslo PainCloud Convention, in which I argued that complex systems theory has many concepts that are useful in understanding the nature of pain.  

One of those concepts is that complex systems are often nested. That means the system as a whole is composed of smaller subsystems, which are also composed of smaller subsystems and so forth.

Where is the pain?

Where is the pain?

For example, people are made up of organ systems (like the nervous system or musculoskeletal system), which are in turn composed of organs (like the brain and spinal cord, muscles and tendons), which are composed of cells (like nerve cells and muscle cells) and so forth. Further, people are parts of larger systems like families and communities and economies.

The reason this is interesting from a practical perspective is that each nested system provides a different level from which we can attempt to explain and treat pain.

Here’s a diagram to illustrate:

Screen Shot 2018-05-11 at 7.17.42 PM.png

At the “lower” levels, you can view the health status of cells and organs like muscles, tendons, discs or nerves. For example, maybe your foot hurts because of a stress fracture. This is where you can find “issues in the tissues”, which is where traditional pain treatment has focused most of its attention. This is often called the “biomedical approach” or the “bio” part of the biopsychosocial model. You find the structure that is damaged and work to repair it.

At the “higher” levels of analysis, such as the person or the environment, you are looking at more complex phenomena – the role of thoughts, emotions, or social relationships. These are the “psychosocial” issues that are known to have very important effects on chronic pain. Problems in these areas are often relatively subtle, more about dysregulation or imbalance than something being broken or injured. These issues are also invisible if you look for them at a lower level. For example, you can’t see catastrophising by assessing a foot – you need to talk to a person. 

Fields of Study

There are many different formal disciplines you could study to get a better understanding at each level. Note that they are very different from one another, and very few people will have significant knowledge at more than one level. 

Screen Shot 2018-05-11 at 7.19.35 PM.png

At the lower levels, you could study biomechanics, exercise physiology or neurodynamics. Each would give you a better understanding of how physical structures in the body respond to stress – either by breaking down and getting injured, or adapting to get stronger.

You could move up a level to study the behavior of a larger system like the nervous system, immune system or endocrine system. This would give you some understanding of how the body mounts a protective response to perceived physical threat. Pain is in the nature of an alarm. The nervous, immune and endocrine systems help set the sensitivity of the alarm, and determine the kinds of events that cause it to go off. “Pain science” is mostly education in the basic physiology of these systems as they relate to pain. 

We can move up another level to the “person”, where we are studying the role of cognitions and emotions in pain. This is the realm of psychology, the relevance of which should be obvious – pain is a psychological event.

Psychological concepts can be very useful in understanding why movement and physical activity help with pain. For example, cognitive behavioral therapy can explain how exercise could extinguish fears or expectancies that might be contributing to pain. In many cases, this perspective is more helpful in choosing an exercise program than one focused on “lower level” concerns about muscle groups, reps and sets.   

You could move yet higher to study the role of social and economic systems. Many social critics would argue that the real pathologies causing a wide variety of chronic diseases – including drug addiction, anxiety, depression, and even chronic pain –  live more at the level of society than the individual. For example, low socioeconomic status is a big predictor of chronic pain. Most readers of this blog are not active in trying to solve problems at this level, but are quite aware that they have a big impact on clinical outcomes.  

Comparing the Different Levels

The terms “high level” and “low level” don’t reflect any value judgment. They merely indicate different perspectives: one is taking a “micro” view of relatively small and simple things like tendons or muscles, and the other is taking a “macro” or big picture look at larger complex things like nervous systems and emotions. 

In general, if you’re moving down levels in your effort to explain some problem, you could call that “reductionist.” And if you’re moving up, that might be called a more “holistic” or “systems thinking” approach.

Screen Shot 2018-05-11 at 7.37.06 PM.png

Again, there is not necessarily any right or wrong here – the right level depends on the context.  Some problems with pain, especially those related to acute injuries, benefit from a lower level approach – strengthen this, stretch that, do X sets of Y reps for Z weeks and then you will be fixed. Other pain problems can never really be “fixed”, and may be hard to manage even with a whole team of psychotherapists, social workers, and attorneys. 

Although each end of the spectrum has its costs and benefits, there is no doubt that until very recently, manual and movement therapists have spent way too much time at the lower levels, looking for issues in the tissues, while ignoring some very real human issues sitting right in front of them. If the “pain science revolution” means anything, it is trying to improve basic literacy at the higher levels.   


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Kriti Old Age/Senior Citizen Day Care Center

What is an Old Age/Senior Citizen care center?

Old Age/Senior Citizen day care is a planned program of activities designed to promote well-being though social and health-related services. Old Age/Senior Citizen day care centers operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. Nutritious meals that accommodate special diets are typically included, along with an afternoon snack.

Old Age/Senior Citizen day care centers can be public or private, non-profit or for-profit. The intent of an Old Age/Senior Citizen day center is primarily two-fold:

  • To provide Old Age/Senior Citizen an opportunity to get out of the house and receive both mental and social stimulation.
  • To give caregivers a much-needed break in which to attend to personal needs, or simply rest and relax.

Benefits of adult day care.

Kriti Health Care, an Old Age/Senior Citizen day care center provider in Delhi NCR region, summarizes the benefits of Old Age/Senior Citizen day care well: “Old Age/Senior Citizen day care offers a win/win situation for everyone in the family—not only the client or member who attends the program, but also for the family member who has primary responsibility as caregiver. Old Age/Senior Citizen day care provides a much-needed respite for the caregiver, affording a break from the physical demands and stress of providing round-the-clock care.”

For the participant, an Old Age/Senior Citizen day care center’s benefits can be extensive:

  • A safe, secure environment in which to spend the day.
  • Enjoyable and educational activities.
  • Improvement in mental and physical health.
  • Enhanced or maintained level of independence.
  • Socialization and peer support.
  • Nutritious meals and snacks.

Is an Old Age/Senior Citizen day care center right for me?

Good candidates for Old Age/Senior Citizen day care centers are seniors who:

  • Can benefit from the friendship and functional assistance a day care center offers
  • May be physically or cognitively challenged but do not require 24-hour supervision
  • Are in the early stages of Alzheimer’s disease
  • Are mobile, with the possible assistance of a cane, walker, or wheelchair
  • Are continent (in most cases)

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Nursing Care Facility at Home in New Delhi and NCR

Nursing Care Facility at Home in New Delhi and NCR

Nursing care at home facility in New Delhi, Gurugram, Noida and other NCR Regions. If you’re like the majority of seniors, you probably want to live at home for as long as possible. You don’t want to loose you feeling of independence. Home care for seniors is healthcare and/or personal care support that’s provided at the home of the elders. It is designed to delay or prevent moving to a nursing home or assisted living center. The thought of paying for an assisted living facility makes your heart flutter. But there are some activities of day to day living like dressing, bathing & sponging, body movement exercise or grocery shopping that can become difficult for some seniors. In-home care provides seniors with home health care, non-medical care and even companionship. You keep your independence and your house. In-home care professionals comes at your home and take care of the elders at your own home.

Nursing care at homefor elders


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Kriti Elder Care Growth

Kriti Elder Care – one of the largest elder care facility in India, we have started with 18 rooms in 2016 and now we have grown to 40 rooms facility in less then the span of two years.

Our aim is to increase our rooms accommodation from 40 to 80 rooms in next one year. We are looking for investment with good return opportunities. People can per-book rooms for their loved ones for long term basis for future also.

Kriti Elder Care Growth Rate


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Shireen Dhar

They take very good care. The people over there are extremely happy and optimistic. Loved visiting.
5.0
2019-01-06T07:50:18+00:00
They take very good care. The people over there are extremely happy and optimistic. Loved visiting.

Romit Ralph

Very nice premises. Really like the place in a green open area and peaceful. Availability of Dr. Sanjeev Tyagi, make...
5.0
2019-01-06T09:21:58+00:00
Very nice premises. Really like the place in a green open area and peaceful. Availability of Dr. Sanjeev Tyagi, make KRITI ELDER CARE a reliable nursing care facility for elders.

Sujata Neha

Very nice retirement home facilities. Well maintained and nice location. Professional doctors for service.
5.0
2019-01-06T09:28:19+00:00
Very nice retirement home facilities. Well maintained and nice location. Professional doctors for service.

Venkat Kishore

A very good elder care nursing home and elder care in Gurgaon. all necessary facilities are available with nice environment...
5.0
2019-01-06T10:03:44+00:00
A very good elder care nursing home and elder care in Gurgaon. all necessary facilities are available with nice environment to live for seniors and elder people.

Tamanna Sharma

Good infrastructure,Helpful Doctors & supportive nursing staff. Peaceful,natural greenery & view of Aravalis are soothing.Physio therapy is added advantage. My...
5.0
2019-01-06T10:05:24+00:00
Good infrastructure,Helpful Doctors & supportive nursing staff. Peaceful,natural greenery & view of Aravalis are soothing.Physio therapy is added advantage. My father is very happy here.
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