One Hot Model 

Louis Gifford’s Topical Issues in Pain has an amazing amount of quality information, and has really inspired many thoughts.

I’ve only read book 1 thus far, but this book can generate material to expand upon much like Supertraining does for fitness writers.

I’m sure many of you folks have seen this picture before.

Gifford called this schematic the “Mature Organism Model” (MOM) to illustrate how pain works.

Inputs from the tissues and the environment travel up the spinal cord to the brain. The brain processes these inputs and samples information from itself to generate a corresponding output. These outputs are perceived as new inputs which reset the cycle.

MOM was of course used to illustrate the three pain types (read here and here), but it is so much more than that.

The MOM is a schematic for how the nervous system works.

Any input that is processed by the brain may or may not lead to outputs of altered physiology and/or behavior.

Viewing (your) MOM (ha) made me think a lot about working with individuals who are dealing with a threat response. How exactly are we helping these folks?

I’ve come to believe that we do not treat outputs. At best we can only provide inputs that we hope are exchanged for new, desirable outputs. In patient care, we are hoping to alter perceived threat. We attenuate threat by giving an individual favorable inputs, which we hope leads to favorable behavior and physiological changes.

Let’s look at what these favorable inputs are by looking at MOM a bit more in-depth.

The Three Inputs

The nervous system can receive information from body tissues, the environment, and itself. Therefore, these are the areas in which we shall provide favorable inputs.

The three input types that can favorably affect the nervous system are:

1. Therapeutic Interventions
2. Therapeutic Interactions
3. Therapeutic Reframing

These inputs can be provided by the individual themselves, someone else, or a foreign object. All three will be needed to some degree, but some will be needed more than others depending on the goal. Let’s dive further.

Therapeutic Interventions 

This input occurs by providing information through tissue receptors. Input types will include most conventional and alternative medicines and performance training.

The primary things we are looking to change with these inputs are:

• System variability – The range at which a system can act
• System capacity – The volume a system can perform with.
• System power – The intensity a system can perform with.

Life is a balance between these three system components, and the degree to which a system must have these components is tailored to an individual’s needs. (ps, my Dad is going to talk about this much better than I here).

Since I am assuming most of my readership is in the movement business, we can look at the movement system.

Movement variability is the ability to move through full ranges of motion actively and passively in three planes. Variability in the movement system follows a bell curve, with movement rigidity for our hypomobile folks and pathological movement variability for our hypermobile folks.

Most conventional therapies that aim to improve mobility and motor control are typically dealing with movement variability. To me, the best system for managing movement variability is PRI, as it is the only one that looks at one’s ability to move well in three planes.

Movement capacity would be how long one can perform before fatigue. Think of any type of training that gets you to do something longer (e.g. aerobic conditioning) as capacity training. In the PT realm, I see graded exposure the way Butler, Louw, and other pain science advocates espouse as building capacity. This training methodology is no different from your favorite conditioning methods.

Movement power would be increasing the force produced in a task. Think weight training and the like.

Therapeutic Interactions

 The target input here is the individual’s environment, and I would argue that this is the most important, and sadly under-discussed, input that a clinician utilizes.

This input’s goal is to create an environment that allows for desired outputs to occur.

If you are a clinician treating someone in pain, you are going to be friendly, funny, empathetic, and an excellent listener (and do stuff I wrote here). Your clinic may have calming colors and scents, and you may want to boot out family members that stress your client out.

If you are a coach getting someone strong, you’ll probably want a bunch of like-minded clients working together getting amped up and playing “my mother never loved me” music.

If you are an individual who lives in a stressful environment, you might change that input by leaving that stressful environment, changing jobs, moving to Arizona, etc.

Therapeutic Reframing

Here we are providing an input that affects the brain’s self-sampling; the mindset. Knowledge is power. The most common discipline that utilizes this input is psychology.

In the movement realm, this input is where therapeutic neuroscience education fits in. This methodology expunges old, deleterious thoughts while simultaneously providing the individual with new, nonthreatening thoughts. This exchange can reduce threat from other inputs.

We provide favorable inputs this way anytime we learn something. Every time you read something educational you are creating new inputs for the brain to sample.

Overlapping Inputs 

Categorizing an input depends on primary intent, but there are several instances in which inputs overlap. We should categorize these inputs via primary, secondary, tertiary intent. For example:

• Putting a hand on someone while they are crying (Primarily therapeutic interaction as you provide an environment for healing; secondarily therapeutic intervention because the touch may provide a calming effect on the nervous system through cutaneous receptors).
• Telling a funny story to educate someone (Primarily therapeutic education because that individual is being provided new beliefs; secondarily therapeutic interaction by making the client laugh).

Last Remarks

This favorable input model provides some insight as to how our clinical/coaching processes can affect the outcomes we seek. While we may have our strengths, creating desired adaptations requires excellence with all three of these inputs.

The best exercise program in the world will not be effective if a client does not does not like you just as your niceness will not outdo your outdated treatments.

Which of these three inputs do you excel at? Which need work? Comment below.