Living With Chronic Pain

Physical therapy for Torticollis

Chronic pain can occur to any part of the body ranging from the big toe to chronic headaches. The most common chronic pain ailments are chronic back and neck pain. Chronic pain was once treated with prescription anti-inflammatory and narcotic medication, but as the opioid epidemic is upon us, we have learned this is no longer the best treatment for chronic pain, but instead only a band-aid. Over time our body learns to become fearful and hesitant to movement. Here are 5 chronic pain strategies that we use as physical therapists to help break the pain cycle and return you to moving once again!

1) Chronic Pain Neuroscience Education– Spending one on one time with you to explain what chronic pain is, why you are in pain, what happens when chronic pain persists, and treatment strategies. This process is called Pain Neuroscience Education (PNE). There is high quality evidence which states PNE helps us better understand pain mechanisms resulting in reduced fear to movement and reduced pain when paired with physical therapy.
What is pain? Pain is an experience which is produced by the brain when the body experiences tissue damage OR perceives potential tissue damage may occur. This means that pain can occur without there being a strain, sprain, break, burn, cut, disc herniation/bulge, etc. You may ask how? This is due to the complexity of the nervous system. Pain is an experience that is multifactorial, not just a signal from our tissues telling our brain that something hurts. Having increased stress, sleep deprivation, illness, anxiety, and depression are just a few examples of factors which may factor into your pain experience

2) Graded Motor Imagery– This is a technique taught to you by your physical therapist in which you think about a particular movement or activity without actually moving. Evidence and imaging shows us that neurons in the brain fire before active movement occurs and with imagining an activity. This is commonly utilized by athletes such as a baseball player predicting where the ball will end up as the batter makes contact with the ball. We process visual information and the brain decides based on past experiences where the ball will likely end up. It then tells our muscles to fire and our body moves in the direction of the ball. Over time your nervous system learns tasks which typically cause pain such as rolling over in bed, moving from sitting to standing, or walking/running which causes the pain cycle to continue.
How do you apply this? Begin imagining yourself performing these learned painful tasks without pain while at rest. This retrains the brain and nervous system to learn that these activities are not harmful to the body and can help reduce pain experienced during them.

3) Treat the Impairment
Mobility exercises – Restoring mobility to joints, muscles, and our nervous system is key to lowering the sensitivity of the nervous system and allowing you to return to the activities you want to do. This can consist of a variety of stretching and other active range of motion exercises.
Manual therapy – Physical Therapy can Address tight and spasmed muscles with soft tissue techniques, improving range of motion and mobility of tight/stiff joints, and desensitization techniques all improve the way we move and reduce the pain we experience.
Aquatic Therapy – The aquatic environment is a great place to start moving again. Its therapeutic properties allow for reduced load on your joints and muscles by reducing the effects of gravity. The 92 degree temperature of the pool often desensitizes your body to reduce the pain you may have traditionally experienced with exercise. The aquatic environment is often a great place to begin to move and elevate the heart rate in a less stressful environment to the muscles and joints.

4) Graded Exposure to Aerobic Exercise– Gradually increasing your activity level is key as our body does not like a rapid increase in activity from the level it is used to. Elevating your heart rate elicits your body to release endorphins which naturally are analgesics or pain relievers. Additionally, aerobic exercise helps reduce inflammation and improve tolerance to your daily activities. This results in desensitization to movement and causing less pain with movement.

We offer free consultations to meet with one of our therapists to further discuss if physical therapy is appropriate for you or any further questions on how you can implement these techniques to reduce your pain! Click here to schedule a consultation.

Written by Trevor Hirsch DPT ( Lewes King Street Row office) and James Alvarez DPT ( Millsboro office) Dr Hirsch and Dr. Alvarez are committed to pursuing specialized training in the effective management of chronic pain through in-depth training in pain neuroscience.

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