This will be an interesting post.  The Sunburn Model?  I was out rock climbing last week and (as what usually happens when my mind is having a vacation) an unbridled metaphor hit me - or developed right on my nose.  'Rudolph the red nosed reindeer' was the reference of the evening with my wife. 

If you have been following our writing here on Return To Movement, you are well aware that the experience of pain can be thought of as a warning signal.  "Possible danger here boss." It's important to reiterate that pain does not necessarily indicate tissue damage, only that the central nervous system (CNS) has deemed a circumstance to be worthy of a warning to take heed.  The CNS is amazing, but it can sometimes be too vigilant or get caught in a circular trap. This is where the pain experience can become persistent (see note below) and debilitating. 

The adjective chronic can evoke thoughts of permanence. Forever saddled with implications of a unlimited existence. Almost like it is set in stone. Persistent feels - at least to me - more manageable and changeable. The pain persists, but what can the “I” do to change it or manage it
— Author Note

Cognitive Functional Therapy (CFT) recognizes that pain is multi-dimensional - originating out of and influenced by biological threats, negative beliefs, fear, despair, anxiety, avoidance and sometimes cavalierism.  When one is caught in the vicious cycle of pain it is meaningful to understand the nature of the warning signal along with the plastic (malleable) characteristics of being human.  The original warning signal said "pay attention - be mindful and considerate."  If you are not, the negative aspects of neuroplasticity can take hold creating the persistent nature of pain.

My Sunburn Model represents one aspect of CFT - graded exposure.  Barring isolated genetic mutation, the human body needs and utilizes sunlight - more specifically UV radiation. It has been recognized in recent years that Vitamin D has a critical role in varied biological mechanisms and end function.  Sunlight on the skin is the easiest way to ensure adequate uptake while the physiological function of the skin cells help to moderate uptake depending exposure. The skin darkens and slowly adapts to gradually protect the skin from minimal overexposure (this is bio-plasticity).  If there is too much exposure - sunburn; too little - inadequate vitamin D.  The middle ground is key. 

Similarly when addressing painful conditions a moderate graduated movement program is indicated.  Focusing on finding the middle ground -  between outright avoidance and too much movement - helps to minimize triggering a painful flare up while addressing CNS protection vigilance.

The correlation doesn't stop there. Modulate sun exposure through time of day, location (elevation, longitude/latitude), frequency, duration and physical barriers (sunblock, clothing coverage). With movement there is frequency, duration, load volume, force direction (open vs closed chain movements), reciprocal loading and weaning of pain medications. 

This gradual exposure is not executed in a vacuum as the cognition processes outlined in CFT are addressed concurrently alongside the physical because of the interplay within the neuromatrix of pain expression. 

One thing to remember is that we all make mistakes no matter how much we try to minimize them.  I became caught up in my enjoyment of rock climbing while my nose innocently became the source of my wife's joking later.  Expect flare ups will possibly occur and know adjustments can be made to hone in on that middle ground for gradual progression.