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Setting the scene: the vast majority of people that come to our clinic do so because of pain that they want to get away from - usually presenting as back pain or headaches etc.

We then explore clarifying questions like, When is it worse? When is it better? What can you do? What can't you do? These concepts are usually quite easy to define, and then the more challenging question; What should we do about it? Which of course is why you've got an appointment.

For the vast majority of people by then we will have established that there is no reason to suspect a significant underlying factor (this is what is referred to often as triage), things like; do we think there's an infection or a broken bone? This is essentially the first key reason for the questions in the first appointment. We want to be clear about what we are not dealing with before we then clarify further towards establishing what we are dealing with. We also ideally want to establish where you want to be (for a lot of people this is far more difficult to establish). Saying where you want to be is 'not in pain' is comparable to saying I want to be 'anywhere but here'; that's really not very helpful if we want a resilient outcome, although it can convey the urgency of the perceived need to change.

So to make things more helpful, it's useful to stablish clearer relativity. I want to be out of pain and I want to be able to get my work done, run 5km and play with my kids. Now rather than a single point to move away from in any direction we have a more clearly defined scale that we can measure progress against - away from one thing and towards another. We might then use ideas of a sat-nav in the car point A is where I am and point B is my destination - plan a route.

Planning the route then is quite easy on the surface of it with a map because you can see where the roads, train lines or paths are. If you're driving, you'll know what the rules of the road are or if you're on the train or bus you'll know with some degree of clarity where your transport goes from and to and at roughly what times. You might for all of these also know what times not to travel, because there's too many other things on in the area. Maybe you'll predictably avoid rush hour if you can because it takes at least twice as long to get there, maybe that makes no difference. Maybe there's scheduled road works that mean you need to take a different route. Or maybe there's a big event on, a festival or a big match which means you may want to travel a different route or go at a different time, or actually that's the precise event you want to arrive on time for.

So, with a bit of meandering, we've set the scene. I want to get away from this thing A (pain) and towards that thing B (goal) and I'd like to do that on this timescale. Delving into the whole concept of SMARTER  targets is covered elsewhere. For now I'd like to explore this journey using a scale as relates to traffic lights. These traffic lights relate to pacing, challenge, threat and progress.  These traffic lights have the familiar colours but different functions, because the rules of the road are different and the map is different. For these traffic lights Green represents playing it safe, really easy, minimal threat, low degree of challenge, using a scale of 0-10 effort we'd score Green as 0-2.

Amber represents a moderate effort, moderate degree of threat, moderate degree of challenge, using a scale of 0-10 we'd score Amber as 3-5.

Red represents playing a more risky game, high effort, high threat, high degree of challenge, using a scale of 0-10 effort we'd score Red as 6-10.

So now we've got our map of where we want to get away from and where we want to get to. Start point and destination. And we've also got our beginnings of our rules of the road; our traffic lights. This however is not your typical journey, so please do not apply these traffic light rules on the road, but for our bodies experience and adaptation they are importantly different. With these traffic lights, green is absolutely a safe and pleasant place to be, in the short term, minimal effort and threat but because of the lack of challenge our bodies adapt over time, this lack of challenge means if we stay in the green zone too long we get weaker, more sensitive, we regress. That's entirely appropriate of our bodies and minds to do, they are always trying to adapt to our environment, if we don't use our muscles, they will get weaker, there's  no point wasting nutrients on maintaining them if they're not needed.

To clarify however, if we've just experienced a large stressful event, if we've just done a hard training session, absolutely it is reasonable to spend some time in the green zone, while you recover before the next effort, but let's not stay there too long or it's no longer recovery.

With amber, this is a really good place to be for training building the foundations, its safe enough that it's not too great of a threat or risk, but it's challenging enough to learn and adapt and get stronger over time. You'll still want to spend some time in the green zone for recovery but you've not shocked an unprepared system. Over time you'll be able to spend more time in the amber zone precisely because of your body adapting.

The red zone is where the more instantly dramatic things happen, either by design or by accident the red zone is a stressful experience for the body and mind. Life events happen to all of us, if they haven't yet, they will, and if they already have then you've got a point of reference and know there will be other things in the future. We can think of stress as good or bad but in either case, it represents a significant departure from the typical daily activities encountered in your environment. It might be that mountain top on the map where you expect the views will be amazing, the really steep climb, the need to carry people or provisions with you along the way. It can be exhilarating and the buzz experience especially when its a planned event or tough training session can also be addictive. What predicts whether it is going to go well though is largely the preparation.

If you spend almost all your time in the green zone and then sporadically jump dramatically into the red zone because it gives you the kick you want, then the chances of being properly prepared are slim. If you go to the gym occasionally and lift some light weights using machines and then one day decide not only to use different equipment requiring a different skill set, but also to push and see how heavy you can possibly go on that same day, the risks of that red zone have mounted. If you go and do that again before you've allowed adequate recovery the risks have mounted further. What we have here, at best, is the yo-yo effect.

To round up, we've got to consider that this is your map, your environment, your interpretation of it, your reality, and they are your traffic lights. Other people standing even in the same room or working in the same job, living in the same house may experience what appears to be the same environment in a completely different way.

References and further reading:

NOI Group: A provider of training and resources for clinicians and clinician directory. https://www.noigroup.com/ - formed part of the inspiration for writing this blog.

Gabbett TJ. Br J Sports Med 2016;50:273280. doi:10.1136/bjsports-2015-095788 excellent review paper on load and recovery in athletes.

Liebenson C. 2020, Rehabilitation of the Spine 3rd edition, Wolters Kluwer; Chapter 37 excellent industry resource.

Pirsig, Robert M.; Zen and the Art of Motorcycle Maintenance: -  A rhetorical, metaphorical and philosophical exploration of the search for Quality in the environment.

Silbernagel KG, Thome R, Eriksson BI, Karlsson J. Continued sports activity using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomised controlled study. Am J Sports Med. 2007;35(6)897-906  an excellent example of the use of traffic light graded system in injury recovery.