Have you ever wondered if the pain that you are feeling is real or if it is just in head? There is a 100% percent chance that it is in your head, because that is where the interpretation of pain occurs. And it is typically there for a reason. Your tissues send warning signs, those signals travel through your nerves and up your spinal cord and arrive in the brain. The brain then process the information and determines whether or not you should feel pain. This is a protective mechanism and has allowed humans to survive and evolve. However, what happens when an injured tissue has healed, but you are still feeling pain. How do you treat that?

Graded Motor Imagery

There’s a step-by-step process that has been supported by literature and research that goes through a concept of created motor imagery. This three step process can be used when a climber has persistent pain in a region even when the tissues have healed.

Step 1: Left-Right Discrimination

Let’s examine this mock demonstration of how we can test laterality, left-right discrimination, for a rock climber who has hand pain. To start, the climber will download the Recognize APP. They will then put it on their device and begin testing by hitting start. They’ll see various images of hands in different positions on the screen and will need to identify whether the image shows a left hand or a right hand. They will then click the left button or the right button to indicate their best guess. Climbers who are unable to accurately identify their affected hand may have a deficit in left-right discrimination. This APP can be used as an assessment tool to determine the accuracy and the time that a climber takes to identify the correct response. This is the first step in treating a climber with centralized pain; this left-right discrimination.

Step 2: Explicit Motor Imagery

The second step is this explicit motor imagery. This is where the climber imagines movements. Now, I want to think about this. Imagine the climber that we discussed earlier with hand pain. Every time that they think about grabbing a rock hold, their hand starts to hurt. They don’t grab the hold, they just think about it. So, we can use explicit motor imagery or imagined movements to start to habituate the central nervous system into the thought and the feeling and the sensation of gripping with the hand without actually doing it. This desensitization or habituation of the nervous system can prepare the climber to eventually get back on the rock wall. This is the second stage, imagined movements or explicit motor imagery.

Step 3: Mirror Therapy

The third stage of graded motor imagery is mirror therapy. We can use a mirror to retrain the stimulus and sensation of the climber gripping with their affected hand. We can see in this image that the climber has their right hand, their non-affected hand facing the mirror. As they look or peer into the mirror, they can see the reflection of their right hand, and it appears as though it is their left hand.

So, the brain is tricked into perceiving that the image they see in the mirror is really their left hand. There are many different ways that we can harness and utilize mirror therapy to progress and habituate a climber into moving their affected limb in their mind and then eventually moving the actual limb.

References

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• Bowering JK, O’Connell NE, Tabor A, Catley MJ, Leake HB, Moseley GL, et al. The effects of graded motor imagery and its components on chronic pain: A systematic review and meta-analysis. J Pain. 2013;14(1):3-13.
• Butler DS, Moseley LG. Explain pain. Noigroup Publications, Adelaide, Australia, 2003.