A Day’s Journey

Navajo reservation (2021; pre-trip)

“How long have you had low back pain?” This is a typical, yet crucial question to ask as a physical therapist to find out if a condition is chronic or acute in order to begin developing a treatment plan. In 2021 I had the opportunity to work on a physical therapy rotation on the Navajo Nation reservation in Red Mesa, Arizona (near the Four Corners national monument). The answer to my first question was met with a rather odd, yet common response from the Navajo patients, “I fell off my horse 20 years ago.” Now the responses weren’t always necessarily 20 years, but that would be the average as most people gave answers in terms of decades. Finding the next words were difficult initially- how do you treat DECADES worth of low back pain?

My love and interest for health coaching grew from this experience when I became exposed to Therapeutic Neuroscience Eduction (TNE). TNE focuses on graded exposure and graded activities to alter a persons response to pain. Essentially when a person suffers a traumatic injury, like falling off a horse, they experience high pain and guarding as a protective mechanism during their initial healing phase. The body is remarkable in its ability to heal, with even the most traumatic of bone breaks healing within months. So WHY would a 20 year old contusion that clearly went through its healing phase still hurt? Well the brain never learned how to stop the influx of pain signals from that original injury area. Think of it like the pain floodgates from the body up the spinal cord to the brain are stuck open and TNE is the intervention that can close that gate.

Research shows that these chronic pain experiences light up the areas of you brain known as the corticolimbic region (intersection of behavior and emotion). The strong link in this area between pain and emotion is why more pain can occur in times of emotional stress or sadness. TNE using Graded exposure has been shown to diminish the signals to this area of the brain therefore decreasing the perceived pain.

How can TNE be applied in your life? Using the guidance of a health coach or healthcare professional, you can create a health behavior change plan of care to address the triggers in your life that cause certain painful conditions. Slow, planned, and gradual exposures to once painful stimuli in order to regain a sense of “normalcy.” Something as simple as hearing, “I can’t go for walks anymore without pain,” leads me to respond with “well how far can you walk right now without pain.” Whether it’s 2 seconds, 2 minutes or 20 minutes- that is our starting point. What would it feel like to go one second, one minute, ten minutes further? Do you still feel safe pushing yourself one step forward?

This is what I love. Empowering individuals to take control of their life and health. Our minds are a powerful tool if we know how to properly apply it. I am so grateful for my time out in the desert connecting with the community and land.