The Transient State of the Nervous System: A Window of Opportunity, Not a Solution [2015 Archives]

This article was originally published on my old blog on September 15th, 2015. Over a decade ago, before instagram and AI.

Looking back, I’m glad I didn’t have AI early in my career. Social media was around, but it wasn’t the constant stream of recycled ideas it is today. You had to spend time reading, connecting ideas, writing things out, and realizing where your understanding fell short.

That process forced you to think.

Today, it’s easy to copy and paste an idea, put it in your own words, and share it without ever really wrestling with it. You can produce a convincing explanation in minutes, or seconds with a chatbot.

Developing the understanding to question that explanation takes much longer. There’s value in sitting with something you don’t understand. Following the references and finding holes in your argument.

I loved that part. And judging by the number of research tabs still crashing my browser, I haven’t changed much.

I’m sharing this as a record of my thinking at that point in my career, and as encouragement to spend time developing your own.

Because, while AI and social media can be useful, they make it easy to skip that process.

And if you do that enough, eventually all you can do is regurgitate everyone else.

The Transient State of the Nervous System: A Window of Opportunity, Not a Solution

The human body is governed by the nervous system. Thus, the state of the nervous system influences every function that we perform, consciously or unconsciously. For brevity and simplicity, lets consider the nervous system as a regulating network that is working behind the scenes, at all times, and is responsible for every action (i.e. output). Far from a physiology lecture on the nervous system, but for context, it is important to know that outputs are influenced by inputs.

Given that the nervous system is constantly interpreting input and reacting with outputs, transient changes occur often. In the world of rehab and training, the transient nature of the nervous system can often be misleading.

For example, doing some breathing exercises may relieve a patient’s back pain. A baseball player may increase internal rotation with a stretch. Ankle mobilizations may increase a basketball player’s dorsiflexion and a shot putter may increase throwing distance after a potentiating throw.

And the list goes on.

In the examples presented, an output was improved by an input. This is simply an acute response resulting from the transient state of the nervous system.

Importantly, this acute response is, by definition, short lasting. Too often, clinicians consider an immediate response from an intervention as a solution. This interpretation is short sighted and may lead to a missed opportunity for meaningful, lasting changes.

Andreo Spina entertainingly demonstrates this idea here (h/t to Matthew Danziger for showing me this video earlier this year):

The takeaway here should not be that making acute changes to the nervous system is a worthless practice. On the contrary, the transient state of the nervous system should be utilized as a window of opportunity to accomplish the desired goal.

This of course assumes no harm done, which includes indirect nocebo effects.

Lets get back to some examples to give this context.

Two basketball players with limited ankle range of motion get some ankle mobilizations via manual therapy from an athletic trainer. After spending a few short moments on the table, the basketball players have increased ankle range.

Player 1 gets taped up and heads on to the court to start practice. The acute change in ankle range doesn’t last long. This is repeated over the course of a season and the player’s ankle range remains limited all season.

Player 2 utilizes this window and instead of heading onto the court, he heads into the weight room to perform some active ankle mobility exercises and some exercises to train the new range of motion. This is repeated over the course of the season and the player’s ankle range and function improve.

Player 1 settled for the simple, less effective approach. Player 2 opted to capitalize on the window and train the acute passive ROM increases to transfer over to functional capacity.

Another example could be the use of isometrics to decrease tendon pain which allows a window of opportunity perform more work and increase capacity of the tendon.

While another example could be the use of acute low back pain relief to encourage graded movement exposure to decrease fear and anxiety, which has implications for chronic pain rehab.

Ultimately, interventions that create acute positive improvements should be used as a means to a greater end; increase the capacity of the athlete or patient to handle the demands placed upon them. This is true in rehab and training.

The takeaway here is twofold: (1) Single inputs do not create long lasting, meaningful changes, and (2) the acute improvement in the outcome of interest should not be interpreted as a solution, rather a transient window of opportunity to create a chronic adaptations.

I like to refer to this process as big picture rehab or training. Don’t stop at the short sighted and single factor approach. Rather, think big picture and capitalize on the window of opportunity to make a lasting improvement in the outcome of interest.

The key is to not fool yourself by misinterpreting the transient state of the nervous system. It is a window, not a solution.

“The first principle is that you must not fool yourself and you are the easiest person to fool.” Richard P. Feynman

Sincerely,

Yours in fitness and health 

Ramsey