Today we’re going to talk about one of our basic neurology rules, which is sensory before motor, and how that applies to pain relief and performance.
One of the basic rules that we talk about when you look at brain anatomy is that a great deal of our brain is actually dedicated to sensory input. If you’ve ever heard me lecture on this, we talk about the nervous system does three things, takes in input, interprets what it means, makes a decision about it, and then creates motor output.
When someone comes to us and they have shoulder issues, knee issues, back issues, one of the first things that we always want to a look at is the quality and quantity of sensory input.
Here’s why this matters to you. If you have a movement issue right now, let’s say you have a sticky left shoulder, you have shoulder pain in internal rotation and abduction, whatever it is.
One of the things that you want to consider is that before you jump into doing a lot of rehabilitation exercises, you might also want to look at sensory rehabilitation. I’m going to give you some very simple ideas and simple rules about how to test things at home that you can then share with your trainer, a therapist, or a physician.
The basics of sensory input from the body are actually not hard to remember. You basically have two different pathways by which information from the periphery makes it up into your spinal cord and into your brain.
One of those is called the dorsal columns and the other is called the ante-lateral system. You don’t need to know that, there is no quiz at the end of the blog. What you do need to know is that they carry different types of sensory information, which means it is possible to have a deficit of one type of sensory information that can cause movement issues and pain.
The easiest way to test this is very simple. What you need to do is collect a few things. We have all these cool gadgets that we obviously use in the real world.
This is called a reflex hammer, but the reason I pulled it out today is in the top and bottom of it one thing that is available is a little brush and this is a pen with a non-sharp head on it. These are kind of cool because they actually represent the two different pathways that we’re interested in.
We have one pathway, as I said, that’s going to basically give us information about light touch like a brush, a towel stroking the skin, and also vibration.
We then have a different pathway that carries information about warm and cool temperatures particularly warm, and then whether or not something is sharp or dull when it impacts the skin.
Why this is really important, like I said, is if you have a shoulder problem, one of the things that you want to do is actually test your shoulder range of motion, your shoulder pain, while you’re providing different sensory stimulus to the area.
If I have shoulder pain, one of the first things I could do would be to take my little brush, test my shoulder on the skin, it’s better on the skin but I didn’t want to do this without my shirt on.
On the skin, actually start brushing the area lightly. Typically, you want to do 20 to 30 seconds of the sensory stimulus while you’re close to that uncomfortable range.
As you’re doing that stimulus, see if your arm moves better.
With the shoulder, obviously you can do the anterior, the middle, the posterior. It doesn’t really matter. You can get into the neck, the elbow, because all this stuff is connected.
Sometimes you have to look around, but the idea, again, is light touch sensory stimulus.
If you’re not sure if it’s a problem, you can compare your left side to your ride side.
Usually the area where you are not moving well will also feel differently. In other words, the sensation coming from that area will be altered.
For pathway number one, we want to look at light touch.
The other thing that you also want to try is vibration.
This is a whole massage unit. This one has got these kind of sharp points on it so you don’t have to have that, but a vibration unit, some kind of massager, is also a great tool that you can use to evaluate this.
Remember the idea is not to sit there in isolation and do the vibration for an hour because the receptors for vibration in the human body actually adapt very quickly.
You want to maybe work on vibration for roughly a minute and then retest your should.
Again, you will often get a better result if you actually get close to the position in which you have the problem.
Use the massager for 60 to 90 seconds, take it off, retest it.
So, pathway number one, we do light touch and vibration. There are other things, but that’s an easy set of exercises to test at home.
Pathway number two, a little bit more weird.
Right here, I have hand warmers. We don’t need these a lot in Arizona but they’re great for actually working on the human body. What you can then do is test warm versus cool. Normally what I do with athletes, we crack open one of these, we actually test the skin, again comparing the non-healthy side to the more healthy side. Does the heat feel different? Does the warmth of this pack feel different side to side?
If it does, again, we aim for 20 to 30 seconds, a kind of light stimulation of heat on that area. Again, you don’t have to leave it on for 15 or 20 minutes. 30 seconds to a minute, just lightly warm the area and then retest.
If you get a good result from that, great.
Your other option for pathway number two is actually sharp and dull.
This one is a little more weird because you want to, again, test it but you can actually take the end of a pen, again, don’t draw blood, it’s your arm.
So, very lightly just see what the sensation is like around that area and compare it to the other side.
If you notice that you have less sensation of the sharp, again, you can get into your position close to where you have discomfort and actually add just a really, really light, again 30 second to a minute, stimulus trying to identify that sensation.
And once again, retest your arm.
This idea of sensory before motor applies to whatever you want to achieve.
If your shoulder is fine and you’re just trying to get stronger, you can also test sensory input.
Often what we find in hard training athletes who may not have pain through injury or other contact, they often have sensory disturbances. Making sure that your brain knows where you are in space by activating all these different sensory receptors will typically not only decrease pain, give you better range, it will also make you stronger.
This is an approach that we use across the board for both pain, high performance. It’s very easy. Remember you have pathway number one, light touch and vibration; pathway number two, warm/cool and sharp/dull.
The biggest idea is you don’t have to do this for a long period of time. Usually, test, 30 seconds of stimulation, retest.
If it improves you, here’s the drill.
You need to actually use this sensory input probably five to seven times a day.
You don’t have to do it for hours, but one minute per hour throughout the day can make a tremendous difference at getting you out of pain and moving better very quickly.
If you have any weird findings with any of this stuff, like, I don’t feel anything, obviously see your health care professional.
Otherwise, just take it easy, go carefully with it, make sure that you’re testing before and after each sensation.
If you have any questions with this, let us know. Otherwise, good luck.