1. + Counsel about activity Lori Montgomery MD CCFP Clinical Lecturer Depts of Family Medicine and Anesthesia, University of Calgary Medical Director, AHS Chronic Pain Centre

2. + Disclosures Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None

3. + Disclosures Prepared with assistance from: Jennifer Greenlay, kinesiologist Shannon Rogers, kinesiologist Safa Rahman, physiotherapist

4. + What a rehab professional might do: Examine assumptions about activity Set functional goals Discuss an approach to beginning exercise Help to troubleshoot problems with exercise Introduce concepts of core stability

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6. + Black-and-white thinking

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9. + “Do it, no matter what”

10. + “Do It No Matter What” Thoughts “I’m fine. I just need to try harder.” “I should be able to do this.” “I have to do it this way.” “Others (kids, spouse, employer, parents) need me.” “I’ll rest when I finish this.” “I feel more pain when I stop, so I’ll just keep going.”

11. Time Activity Level Tolerance “Do It No Matter What” “Do It No Matter What” and Function

12. + “Wait until…”

13. + “Wait Until” Thoughts: “What if I cause more damage and make my pain worse?” “This is really going to hurt.” “If I can’t do it like before, what’s the point?”

14. Time Activity Level Tolerance “Do it no matter what” “Wait Until” “Wait Until” and Function

15. + Pacing Approach Time Activity Level Tolerance “Do it no matter what” “Wait Until” Pacing

16. + Hurt = Harm

17. + Pain is an alarm

18. + Start with a level of activity that doesn’t flare your pain by more than 3 points Start with a level of activity you could do even on a bad day Start with a level of activity that feels safe

19. + Pain is an alarm Increase by 10% in either frequency or intensity every week/month etc. Aim to do your activity every day Once you’ve progressed, have a back-up plan for days when pain is flaring – still active daily

20. + “Four food groups of exercise” Aerobic Muscular Strength and Endurance Core stability Flexibility and Joint Range of Motion

21. + Core Fundamentals

22. + We describe the “core” like a pop can Diaphragm Deep abdominals Deep back muscles Pelvic Floor All sides of the canister (muscles) need to be able to accommodate and adapt to pressure changes within the abdominal cavity

23. + Core Fundamentals “Core Stability” describes a dynamic system that responds to change Think of it as “Core Control”

24. + Core Fundamentals The “Crushed pop can”

25. + Core Fundamentals

26. + Advice for Patients Elongate spine Lift ribcage away from pelvis Engage core muscles Practice breath awareness Practice proper body mechanics

27. + When you have back pain Think about using legs, gluteals instead of back muscles (rising and sitting) Unlock the knees Pay attention to stance and gait