For people living with chronic pain, long-term prognosis is often filled with metaphorical rainstorms, deceptive winds, and long dark nights. When pain is present, the most noticeable feature of a client's changing climate often revolves around biomechanical limitations and movement limitations. Perhaps not so obvious (and often equally stressful) are the emotional and psychological factors associated with the regular pain sensation.
In order to create a truly unique, multi-dimensional strategy for people with pain, it is imperative that you go beyond pain optics of biomechanics and connective tissue principles alone. Take a walk through the four seasons of chronic pain and see how you can help your clients make a smooth transition.
First season ̵
When such avoidance behaviors manifest, it is clear that attempting to treat chronic pain solely from a biomechanical perspective is an incomplete approach. The Neuromatrix Theory of Pain suggests that the pain output is regulated by afferent sensory mechanisms in conjunction with cognitive inputs (Melzack, 2001). These cognitive inputs have the ability to regulate and increase anxiety, anxiety, depression and self-doubt. All of this falls into the category of mental / emotional stressors.
These stressors contribute significantly to the stressful winter climate. Customers suffering from pain seem to endure the dark and ominous atmosphere of winter sometimes infinitely long. To help customers succeed in the winter transition, the difference between a customer's "external" and "internal" issues needs to be understood.
The Second Season – Spring  The melting of snow, the reduction of precipitation and the awakening from hibernation are welcome signs that winter is almost over. In order to lead health and exercise professionals to a better climate, the internal problems of each client need to be understood.
All clients with pain have two global problems. The "external problem" is the biomechanical or anatomical concerns that each client encounters during initial consultation. For example, consider the customer who has had knee pain for years. Knee pain is the outer problem. However, the "inner problems" can be those areas of life that are most important to people who are adversely affected by chronic pain. The inner problems are the emotional, psychological and social / environmental burdens unique to the individual.
For example, consider a husband and wife who spend meaningful time each day walking with their dog. In recent months, however, the knee pain (external problem) of the man has become so problematic that he is prevented from participating in the most meaningful aspect of his day, which joins the evening walk with his wife (internal problem).
A client's emotional transition from winter to spring starts with his or her health, and it is professional when he or she perceives the client's inner problems. This awareness then offers both the coach and the client the opportunity to write a new, more desirable narrative based on the values that the individual customer most appreciates.
The third season – Summer (possibility)
In order for seeds and seeds to reach their full potential, a favorable climate is required. Customers who have pain, anxiety, anxiety, hopelessness, and negative self-talk are the metaphorical weeds of insight. If these weeds are ignored, they can pull the progress forward. In the summer months, the seeds of the possible must be maintained and the cognitive weeds regularly pulled.
As with any trip, there are small setbacks and moments of self-doubt (especially in chronic pain). Therefore, involving clients in the process of designing forward-looking, growth-oriented opportunities becomes imperative. The Yellow Brick Road calls this process a "Possibilities Paradigm" and includes four steps, all of which serve to reinforce and enhance the emotional and mental resilience and well-being of a client. If successful, these four steps can help spark hope and reassure each customer's current and future outlook.
The Fourth Season – Fall (self-regulation)  In the fourth and final season, customers return to a pain-free life. While there are a variety of factors that affect the painless transformation of each individual (including biomechanics), the ability of a client to accurately assess and regulate one's own emotional state (self-regulation) contributes to his or her own to overcome inner problem (s).
Consider the experiential difference in self-regulation in the following two statements: "Oh no, I just kicked my back out!" "My back has tightened, but I know it protects only my body. "These are two completely different emotional responses, the former full of fear and the latter as a perception of safety and protection.
It is of course not possible to prevent negative feelings of the clients. However, as health and exercise professionals, we can strive to create a climate that enhances each client's self-regulatory skills and helps them identify and overcome the emotional and psychological stressors that contribute to their pain. Importantly, you can begin this process with your customer even before you have completed your biomechanical assessment.
Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65, 12, 1378-1382.