• Home
  • About
  • Articles
  • Coaches
    • Jamie Johnston
    • Ben Cormack
    • Laura Allen
    • Walt Fritz
    • Todd Hargrove
    • Robert Libbey
    • Meaghan Mounce
    • Dr. Erson Religioso III
  • Courses
  • Contact
  • Search
  • Menu Menu
  • Facebook
  • Twitter
  • LinkedIn
  • Instagram
Become a Contributor

Graded Exposure

January 2, 2017/1 Comment/in Massage, Massage Clinic, Massage Therapist, Massage Therapy /by Todd Hargrove

Graded exposure is a key concept in understanding how to reduce pain caused by movement.It’s a very common sense idea, and one that most people kind of know at some level, because there is profound truth to it.

But it’s also an idea that most people will probably fail to put into practice in a systematic way. Here’s a brief discussion of what it is, why it works and how to do it.

What is graded exposure?

Graded exposure is a process by which you slowly and progressively expose yourself to some form of stress, in order to make you less sensitive to that form of stress.

In the context of movement, it means the progressive introduction of threatening movements, in the right dosage and timing, in a way that makes them less painful. This might happen in one of two ways – through causing a change in the body, or a change in the way the nervous system perceives threats to the body.

Tissue Adaptation – Make Your Body Stronger

There is some physiological truth to the idea that what doesn’t kill you makes you stronger.

According to the SAID principle, the body will adapt to get better at withstanding specific forms of stress, provided they are experienced to a sufficient degree.

For example, when the muscles are stressed enough by lifting weight, this causes micro damage that stimulates changes in muscle physiology. These changes will make the muscles stronger and less likely to get damaged by the same weight in the future.

With this principle in mind, you can get stronger and stronger by progressively overloading your muscles over time.

The trick is to expose yourself to stress in a graded manner – enough to stimulate adaptation, but not enough to cause injury or prevent healing.

The same principle can be applied to rehab injuries, especially overuse injuries like tendonosis.

The difference is that in this context, getting the right timing and dosage is much more difficult, because the likelihood of injury or incomplete recovery is greatly increased. This makes it harder to find the “sweet spot” where you apply enough stress to cause adaptation, but not enough to cause or worsen injury.

A careful and systematic approach is required.

For example, if you are currently experiencing pain in your foot after running a mile, you could try running just short of a mile, and then slowly inching your way upwards in distance, making sure that you are not making the pain worse.

If you succeed, this might be a sign that you are applying enough stress to the tissues to get them to beneficially adapt, but not enough to cause injury or prevent them from healing.

Most clients find this strategy fairly easy to understand, if not to apply.

The more complicated explanation for why graded exposure might reduce pain associated with a particular movement is that it makes the nervous system less threatened by the movement, even though the tissues are not really adapting in any meaningful way.

Nervous System Adaptation – Disassociate Pain And Movement

We experience pain in relation to movement when the nervous system perceives that the movement is threatening to the body.

Like other perceptions, the perception of threat is an interpretation that is subject to change based on a wide variety of information. A program for graded exposure can offer the nervous system new information about a movement that might cause a change in perception.

If you can find a way to perform a currently painful movement at a low enough intensity that it does not hurt, you are sending the nervous system feedback that the movement is safe.

If you do this repeatedly, perhaps the nervous system will start to disassociate the movement from the pain.

This is the same rationale underlying many treatments for anxiety and phobias.

Here’s an analogy to illustrate. If a child wanted to convince his overprotective mother that it was safe to play at the playground, he would first need to show her that he can play without getting hurt.

A good strategy would be to start slowly with the safest activities, and then move to more dangerous ones, all the while showing Mom he is safe from injury or threat.

Hopefully Mom will eventually chill out.

You can go through a similar process of graded exposure to show your nervous system that a particular movement is safe. If running three miles causes panic, try running just one and see if that is acceptable.

Then slowly inch the mileage upward and monitor the response.

Summary: Graded Exposure Sends Good News

A major goal of any program for movement health should be to send as much “good news” to the nervous system as possible about the state of the body, and its ability to withstand the stress of movement.

Whether this is done by making the body stronger, or making the nervous system less concerned about the strength of the body is sometimes irrelevant.

Either way, the formula for movement success is the same.

Start moving how you want to move, make sure you’re not in pain during the process, and then move a little more next time. That’s graded exposure, and it’s how we get better at anything. Like many other ways to improve health, it’s simple but not easy.

Todd Hargrove

Todd Hargrove is a Certified Feldenkrais Practitioner and a Certified Rolfer living and practicing in Seattle. He became interested in movement and pain twenty years ago, when as a lawyer, he was trying to treat his own chronic pain and win more squash matches. He got some great results, and eventually changed careers to help others make similar improvements. In 2008 he started writing a blog at bettermovement.org to share knowledge with a wider audience. His writing seeks to explain why pain science and neuroscience is relevant to manual and exercise therapists. He recently published a book called “A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain”.

  • Author
  • Recent Posts
Todd Hargrove
Follow Him
Todd Hargrove
Todd Hargrove is a Certified Feldenkrais Practitioner and a Certified Rolfer living and practicing in Seattle. He became interested in movement and pain twenty years ago, when as a lawyer, he was trying to treat his own chronic pain and win more squash matches. He got some great results, and eventually changed careers to help others make similar improvements. In 2008 he started writing a blog at bettermovement.org to share knowledge with a wider audience. His writing seeks to explain why pain science and neuroscience is relevant to manual and exercise therapists. He recently published a book called “A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain”.
Todd Hargrove
Follow Him
Latest posts by Todd Hargrove (see all)
  • Play Involves Risk - March 22, 2021
  • Posture, Babies, And Bathwater - January 25, 2021
  • What Kind of Exercise is Healthiest? - November 17, 2020
Tags: Massage, Massage Clinic, Massage Therapist, Massage Therapy
https://themtdc.com/wp-content/uploads/Untitled-design-5-2.png 400 600 Todd Hargrove https://themtdc.com/wp-content/uploads/logo.svg Todd Hargrove2017-01-02 12:05:462020-08-20 12:21:53Graded Exposure
You might also like
Articles Of The Week June 23, 2019
Functional Mobilization To Improve Squats
Articles Of The Week April 12, 2020
Red Flags For Low Back Pain, Or Clinical Decision Making?
The FAST Way For Massage Therapists To Recognize A Stroke
Best manual therapy articles of the week for March 14, 2021 Articles Of The Week March 14, 2021
Tips For Writing Amazing Massage Therapy Blog Posts
Should Massage Therapists Stretch Athletes Pre-Performance?
1 reply

Trackbacks & Pingbacks

  1. Differences In Graded Exposure And Graded Exercise « The Massage Therapist Development Centre says:
    November 20, 2017 at 7:09 pm

    […] a great piece on how to start implementing graded exposure in your practice which you can read here. If you don’t follow Cory Blickenstaff, check out his blog forwardmotionpt.com where he talks […]

Comments are closed.

Categories

  • Business
  • Cardiopulmonary Resuscitation
  • CPR
  • Emergencies
  • First Aid
  • First Responder
  • Massage
  • Massage Clinic
  • Massage Therapist
  • Massage Therapy
  • Mental Health
  • Myofascial Release
  • Nutrition
  • Pain
  • Pain Science
  • podcast
  • Posture
  • PTSD
  • Social Media
  • Sport Massage
  • Therapeutic Exercise
  • Uncategorized

Join and stay up-to-date!

Email Marketing by AWeber

Have a solution to a problem within our industry? We want to hear about it!

Learn More

© 2020  James Johnston RMT • All Rights Reserved
Website by Caorda Web Solutions

Todd Hargrove

Todd Hargrove is a Certified Feldenkrais Practitioner and a Certified Rolfer living and practicing in Seattle. He became interested in movement and pain twenty years ago, when as a lawyer, he was trying to treat his own chronic pain and win more squash matches. He got some great results, and eventually changed careers to help others make similar improvements. In 2008 he started writing a blog at bettermovement.org to share knowledge with a wider audience. His writing seeks to explain why pain science and neuroscience is relevant to manual and exercise therapists. He recently published a book called “A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain”.

  • Author
  • Recent Posts
Todd Hargrove
Follow Him
Todd Hargrove
Todd Hargrove is a Certified Feldenkrais Practitioner and a Certified Rolfer living and practicing in Seattle. He became interested in movement and pain twenty years ago, when as a lawyer, he was trying to treat his own chronic pain and win more squash matches. He got some great results, and eventually changed careers to help others make similar improvements. In 2008 he started writing a blog at bettermovement.org to share knowledge with a wider audience. His writing seeks to explain why pain science and neuroscience is relevant to manual and exercise therapists. He recently published a book called “A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain”.
Todd Hargrove
Follow Him
Latest posts by Todd Hargrove (see all)
  • Play Involves Risk - March 22, 2021
  • Posture, Babies, And Bathwater - January 25, 2021
  • What Kind of Exercise is Healthiest? - November 17, 2020
Scroll to top

This site uses cookies. By continuing to browse the site, you are agreeing to our use of cookies.

OK

Cookie and Privacy Settings



How we use cookies

We may request cookies to be set on your device. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website.

Click on the different category headings to find out more. You can also change some of your preferences. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer.

Essential Website Cookies

These cookies are strictly necessary to provide you with services available through our website and to use some of its features.

Because these cookies are strictly necessary to deliver the website, refuseing them will have impact how our site functions. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. But this will always prompt you to accept/refuse cookies when revisiting our site.

We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. You are free to opt out any time or opt in for other cookies to get a better experience. If you refuse cookies we will remove all set cookies in our domain.

We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Due to security reasons we are not able to show or modify cookies from other domains. You can check these in your browser security settings.

Other external services

We also use different external services like Google Webfonts, Google Maps, and external Video providers. Since these providers may collect personal data like your IP address we allow you to block them here. Please be aware that this might heavily reduce the functionality and appearance of our site. Changes will take effect once you reload the page.

Google Webfont Settings:

Google Map Settings:

Google reCaptcha Settings:

Vimeo and Youtube video embeds:

Privacy Policy

You can read about our cookies and privacy settings in detail on our Privacy Policy Page.

Privacy Policy
Accept settingsHide notification only

Clinical Pain Science For The Low Back, Pelvis And Hips

This course will be presented over a zoom meeting.  Details will be sent after you register.

Clinical Pain Science For The Low Back, Pelvis And Hips Remote

  • Price: $ 500.00 CAD