Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management.

BACKGROUND: The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications. OBJECTIVE: We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention. CONCLUSIONS: The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.

The Kettlebell Lunge Clean exercise.

Functional movements are designed to look at how our body functions in different environments. Power is often performed in the vertical plane and very stable positions of the body. Both life and sport require a great deal more complexity of movement with direction and deceleration playing key roles. The Kettlebell Lunge Clean (KLC) exercise is a safe and powerful exercise to teach these qualities and progress the power development and force absorption capabilities of the individual.

Training the hip: a progressive approach.

In this article a progressive series of exercises to enhance motor control or movement competency of the hip are described. The training begins with control of center of mass during forward leaning by the muscles of the sole of the foot. This progresses to a novel lunge exercise emphasizing eccentric quadriceps control the knee. Then gluteal training is shown in a modern variation on Tai Chi along with a hip stability exercise during trunk rolling movements.

Musculoskeletal myths.

This paper discusses a number of common myths in the musculoskeletal pain management and rehabilitation/athletic development fields. The origins or rationale for these beliefs are reviewed. New scientific evidence disputing or refuting the myth is then presented followed by and explanation and evidence for an updated perspective.