Ppt About Directing Management

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					                                          Performance Pain         Can make pt feel
                                            Viewed as +              Satisfied
       Pain Management                      Acute                    Inspired
                                            Short in duration        May performance
                                            Produced voluntarily




Injury Pain        Can make pt feel       Benign Pain              Harmful Pain
  Viewed as –        Loss of confidence     Dull                     Localized to area of
  Chronic             anxiety               More generalized         injury
  Uncontrollable     fearful                Short in duration        Persists after exertion
  Signals danger                                                     Swelling
                                                                     Prolonged soreness




                                                                                               1
          Characteristics                                 Scenario #1
Subjective                                    A distance runner who has the perception
Influenced by prior experience                of a burning feeling in her legs as she
Location                                      climbs a hill. Evaluating this perception in
                                              comparison to prior experiences, she
Intensity                                     determines that the meaning of this
Type                                          burning feeling is routine performance
                                              pain. The likely action to follow is to
                                              continue running.




            Scenario #2                       Scenario #2 different version
Following the perception of burning pain in   A swimmer feels neck pain.
his S’, an athlete concludes that an injury   What can could be one of the
is developing (meaning). What should be       perceptions?
he action?                                    What is the meaning?
                                              What is the action necessary?




                                                                                             2
              All of the possibilities                                                   Pain Assessment
    Meaning could be:                                                          A simple continuum
        Good effort                                                              Rating
        Injury                                                                   Type of pain
        Survival situations                                                      Multiple times/day
    Action could be:                                                           Journal
        Maintain pace                                                            What should they record?
        Stop activity




      Continuum
                                                                               What type of information can these instruments
                                                                                       provide to us as care givers?

                                                                               Helps recognize & discriminate b/t
                    100                                                        different levels of pain (benign vs. harmful)
                     90
                     80                                                        Identifies when they are having the pain
                     70
                     60                                                        What they are doing when having pain
                     50                           pain
                                                  level
                     40
                     30
                     20
                     10
                      0


What type of information can these instruments provide to us as care givers?




                                                                                                                                3
                                2 foci
   Pain Reduction                                                              Pain focusing          Involves directing
                                                                                 Association          attention onto the pain
       Act directly on the physiological aspects of the                              OR               Involves directing
       pain, ↓ the amount of pain                                                Dissociation         attention away from the
                                                                                                      pain

                                                                                                         rhythmic cognitive act.
                                                                                                         Pain acknowledgement
                                                                                                         Dramatic coping
                                                                                                         Situational assessment
Diminishes autonomic changes asso with increased pain, like vasoconstriction
and muscle spasm, there by decreasing the release of norepinephrine




                    Deep Breathing                                                      Muscle Relaxation
   Very simple                                                                 Used in a variety of settings
   Easily done any where; easy to                                              Helps pt gain control over pain
   incorporate into rehab                                                      Helps reduce pain levels
   Increases blood flow; increase O2 to cells




                                                                                                                                   4
                Meditation                                                  Meditation
Creates a state of physical relaxation &                   Primary value
psychological tranquility                                    Deep relaxation
The Relaxation Response                                      Acts as a distraction from pain
  Mantra                                                     Focus is on something pleasant
    Sound that is said to have relaxing effects i.e. one
    is the word that you focus on
                                                             May reduce – emotion asso w/pain
    2x/day
    Quiet room/get comfy
    Close their eyes, repeat the mantra to themselves




                 Massage                                                  Pain Focusing
Primary concern – manually manipulate                      Dissociative                       Associative
muscles and ligaments                                        Involves the athlete’s               Direct attention onto
                                                             attention away from                  the pain
Used in conjunction w/ deep breathing,                       the pain                             Interpret it in a
imagery, ice, heat, & stretching                             And on to something                  different way so that
                                                             else                                 You can change the
Goal – reduce pain by breaking the pain-
                                                                                                  perception of the pain
spasm-pain cycle
  Petrissage
                                                                       An internal versus external focus




                                                                                                                           5
              External Focus             Methods of External Focus #1
In general – the more you focus on the   Pleasant imaging – generating pleasurable
pain; the more you feel it               images
Must use                                 Directs focus away from pain onto
   Visual                                pleasant images
   Auditory                              Will induce relaxation
                                         What would be something that you would
                                         imagine?




                          #2                                   #3
Neutral imaging –                        Rhythmic cognitive         Provide an example
focusing on emotional                    activity – focus on        of an activity
detachment
                                         repetitive or
Imagine a captivating
                                         structured tasks
activity and put yourself in
it
What would be something                  Moderate degree of
you would imagine?                       attention




                                                                                         6
                       #4
Pain acknowledgement – pt focus on pain
while looking at it in a different light

Give it physical properties
  Color, sound, size




                                           7
                    #5                                         #6
Dramatic coping – putting the pain in a     Situational assessment – involves
different context i.e. a grand challenge    evaluating the situation that is causing the
Creating fantasies –                        pain and using the info to adjust the
                                            situation to ↓ the pain




When can dissociation be harmful to the
pt?
  Pain is an indicator of another problem
  Less effort by the pt




                                                                                           8

				
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