Pinnacle Health Sports Medicine: The Mind-Body connection of Injury & Rehabilitation

Transcription

1 Pinnacle Health Sports Medicine: The Mind-Body connection of Injury & Rehabilitation May 21, 2017 Stu Singer, PsyD (ABD) App: DoSo

2 What we know: Athletes are a unique population in terms of injury rehabilitation. Identity is connected to sport teammate, body, social community, continuity, purpose, and structure There is a natural grieving process (Pargman, 2011)

3 So There are potential psychological hurdles (non-clinical): Anxieties Down mood Stress Identity/Role questioning Isolation

4 The obvious greater issue is that if these hurdles aren t recognized or addressed it will have a negative consequence to rehabilitation: Delayed recovery Lack of motivation Limited adherence Compromised nutritional intake Fear re-injury, never be the same, lose spot Hyper-motivation overtraining

5 Mind-Body System Approach

6 Injury and rehabilitation = Body AND Mind are under stress

7 Build your awareness of psychological stressors that interfere with recovery: What if fears = predictions Perceived lack of control Worry based in past/future thinking Normalize the concerns Caught up in judgment Build in belief into the process/protocol the biological impact of belief start and finish with successes (ex. Golf- first and last hole)

8 So what happens when the athlete/patient is overwhelmed or stressed? FEAR!

9 Understanding fear and its relationship to mind-body health: Our brain is designed at its core to keep us alive. It s strongest and most powerful form of processing is the survival instinct. Fight or flight response This mechanism is housed in the amygdala. Fallacy = that we can simply say, stop having fear, or be fearless.

10 However, what we can do is get better and better at distinguishing real danger from perceived danger (ex. [real] walking to edge of cliff; [perceived] foul shot, PK, putt, pitch, field goal, rehab/pt) And we can get better and better at how we experience the fear/emotion that we do feel in these moments creates reduction in stress Biomarkers that are typically associated with optimal health improve these markers include blood pressure, stress levels, sleep cycles, decrease in cortisol, visceral fat

11 Connect with the science: We teach an understanding of sympathetic and parasympathetic nervous system functioning Want them to understand their connection to recovery beyond just the physical part of rehab

12 Sympathetic = Fight of Flight; increased heart rate, quick and shallow breathing, digestive system slows, muscles tighten, slower processing (Gas Pedal) Parasympathetic = calms fight or flight; relaxation response (Brake Pedal) Homeostasis between = sweet spot

13 How the neuroplasticity of repeated experiences changes the brain: We can actually strengthen our synaptic connections based on repeated practice. When you look at the brains of those that rehearse specific mindset practices, the areas related to attention, learning, and composure grow bigger and stronger.

14 The process is known as Cortical Thickening: the growth of new neurons in response to repeated practice. What we practice grows stronger. (ex. muscle growth, or ligament repair) As the amygdala shrinks, the pre-frontal cortex associated with higher order brain functions such as awareness, concentration, and decisionmaking becomes thicker. The connection between the amygdala (fear) and the rest of the brain gets weaker, while the connections between areas associated with attention and concentration get stronger.

15 What we now know about training the brain: Mindset workouts (Mindfulness) work: It strengthens our immune functioning, it decreases stress, decreases cortisol, helps us sleep better = ^healing We also know that it s a false premise that shame and selfjudgment are universal tools for self-improvement: We have this mistaken belief that if we beat ourselves up, we ll somehow improve. (ex. D3 basketball player)

16 Physiologically it can t work because when we beat ourselves up, the amygdala (fear center) triggers norepinephrine and cortisol to flood our system shutting down the learning centers and shuttling our resources to survival pathways (fight or flight). Sooooo beating ourselves up literally robs the brain of the energy it needs to do the work of changing.

17 And worse, when we beat ourselves up, we want to avoid it, so we hide from the things that we re ashamed of the parts that MOST need our attention Example: an athlete that doesn t want to practice the very thing they are weakest at; or the patient that avoids the rehab/prehab movement that they are weakest at, yet does what they are already strong with).

18 What we ve worked on: Placing our athletes under high sympathetic load, and then teaching them skills to kick-in parasympathetic response. Allows body to recover = ^healing Can better regulate fears and worries = ^healing Fear/stress response decreases = greater willingness to take on challenge/discomfort = ^ outcomes Increase in present moment focus = ^ attention and learning Decrease in outcome predictions/anxiousness = better sleep = ^healing

19 Our Mindset workouts teach our athletes to intentionally pay attention to THIS present moment with no judgment (being mindful): Non-judgment gives us the courage to take on challenges. Non-judgment open to anything intention releases dopamine. This turns on the learning centers of the brain and gives us the resources we need to take on challenge. Committed positive mindsets over long periods (rehabilitation process) requires this higher-order of attention.

20 Mindset Exercise - Intentional Focus Thoughts Single point of attention Let Go Return

21 6-1-7 (centering) breathing Learn to regulate system Reminder to stay present Muscle growth happens in recovery

22 Final take-aways: Mind and Body are under stress calm the mind; calm the body Sympathetic and Parasympathetic balance and find the sweet spot Stay in the present Understand and teach belief Create the Can mentality Accept the down days don t let them swim in them!

23 Questions?

24 Bibliography: Dispositional Mindfulness Co-Varies with Smaller Amygdala and Caudate Volumes in Community Adults Taren AA, Creswell JD, Gianaros PJ (2013) Dispositional Mindfulness Co-Varies with Smaller Amygdala and Caudate Volumes in Community Adults. PLOS ONE 8(5): e doi: /journal.pone Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain Neuroscience Letters, Volume 520, Issue 2, 29 June 2012, Pages F. Zeidan, J.A. Grant, C.A. Brown, J.G. McHaffie, R.C. Coghill How Does Mindfulness Meditation Work? Proposing Mechanisms of Action from a Conceptual and Neural Perspective. Sage Journals (2010) Hölzel, B.K., Lazar, S.W., Gard, T., Zev, S.O., Vago, D.R., & Ott, U. A brief mindfulness and yoga intervention with an entire NCAA Division I athletic team: An initial investigation. Psychology of Consciousness: Theory, Research, and Practice, Vol 1(4), Dec 2014, Goodman, Fallon R.; Kashdan, Todd B.; Mallard, Travis T.; Schumann, Mary A pilot study investigating changes in neural processing after mindfulness training in elite athletes Lori Haase, April C. May, Maryam Falahpour, Sara Isakovic, Alan N. Simmons, Steven D. Hickman 1, Thomas T. Liu and Martin P. Paulus

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