What is Graded Exposure?
Graded Exposure plays a key part in understanding how to reduce pain caused by movement. It is the process by which you slowly and progressively expose yourself to some form of stress, in order to make your body less sensitive to that form of stress.
When related to movement, it means the progressive introduction to threatening movements which cause pain. It must be done with the right amount, at the right time and in a way that makes the movement less painful.
The idea behind it is to decrease the sensitivity in your body that is associated with the threatening movement and to reassure your body that it is able to do this movement once again.
Graded Exposure is not new. It has been around for a while. It can be explained in two ways – one is to cause a change and adaptation in the tissues of your body and the second is to change the way your nervous system perceives a threat in your body.
The first example of body adaptation could go like this. When you go to the gym and lift weights, you are exposing your muscles to stress. Its not enough to cause injury or pain, but it does cause micro-damage to the muscle and your body adapts by making it stronger and more robust. When you are very confident at lifting that weight, you then move onto a heavier weight. Your body adapts again, and becomes more robust.
The trick is to expose yourself to stress in a graded manner. Enough to cause the muscle to adapt, but not enough to cause injury or prevent healing.
Another example is of a runner getting knee pain at the 5km mark. They could then take it back a notch and see do they get pain at 4km. If not, then they could go to 4.25 km as so on until they once again get to 5km with out pain. Here, the tissues have adapted.
The second way in which graded exposure can be explained has got to do with the nervous system.
We experience pain in relation to movement when the nervous system perceives that the movement is threatening to the body. Remember that pain can be based on the perception of threat and does not equate to tissue damage. This perception of threat is also based on a lot of other things like previous experiences, fear, emotions and beliefs about your pain.
If you can find a way to perform the painful movement at a lower intensity, with less fear and worry and it does not hurt, then you are sending back positive feedback to the nervous system that the movement is safe. If you do this enough times, then the nervous system will acknowledge that the movement is safe and not associate it with pain anymore.
This is the approach that works with people who have been in pain for a long time and their pain is no longer about tissue damage. It is about sensitivity of their body.
An example of this would be a person who hurt their back by bending down to clean out the fire and it led to a lot of pain, distress and time off work. This movement is now associated with pain and the person is very fearful when it comes to cleaning out the fire again. So a graded exposure plan needs to be put in place that exposes the person gradually to bending down. Once they are comfortable bending down, then twisting and reaching movements can be added and finally some weight.
The goal is to be able to get them back to cleaning out the fireplace with thoughtless, fearless movement.
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Conclusion: Makes perfect sense but not always easy to follow
Graded exposure should be the aim of any rehab program. It makes perfect sense that you need to start introducing yourself to the threatening movement, bit by bit, so that you can achieve that movement. It is basically how we learn skills.
It is so important for anyone who has been in pain for some time to try and break their pain habit and give their body the experience of moving without pain. The more we can do this, the less sensitive their body becomes. So the formula is simple. Break down the movement you want to do. Move a little bit with no pain and then move a little bit more the next time.
However, like a lot of things associated with health care, it sounds simple but is in fact not that easy to do without guidance, support and ecouragement.