•  
  • persistent pain (11)

Your cranky nerves: A primer for patients to understand pain

Tags: No Tags
Comments: Comments Off
Published on: June 10, 2013

Audience: Patients with any type of pain or injury

Purpose: to learn a little about pain and convince you that pain is not in your head even though your brain plays a big role

Why? Understanding pain helps decrease pain and helps us make better choices in the treatment of injury

Some brief pain information tidbits

  • you don’t need a leg to feel pain in that leg (e.g. phantom limb pain)
  • you always need a Brain to feel pain
  • pain can become a habit – and like all habits lots of factors help keep it going
  • Changes in how we feel pain can also come from changes in the brain and the nervous system
  • tissue damage or degeneration does not have to lead to pain – but it certainly can

Damage does not always equal pain

220px-Lagehernia
This herniated disc does not always hurt

The idea that lots of pain equals lots of damage is a very difficult concept to shake.  It is entrenched in how we think about pain, arthritis, surgery and injuries.  When we have pain we want to know what is causing it. We assume there must be something damaged and that causes our pain.  The problem with this is that the majority of us are walking around with some degenerative joint disease, disc protrusions, tears in our shoulder rotator cuff and all kinds of things that look like damage YET we have no pain.  Conversely, you can have a lot of pain and all the imaging shows that there is no damage.  This can be extremely frustrating for someone in pain. Take a look at this rather dry post that details a number of research studies showing the poor relationship between joint damage and pain.

However, sometimes damage certainly does lead to pain.  If you break your arm it will hurt.  But in a week, that arm will still be broken but you can be out of pain.  I also know, that many people with hip degeneration are in a lot of pain, they then get a hip replacement and they are out of pain.  This is wonderful.

So why does some damage end up leading to pain and other damage doesn’t?

Several factors can contribute to our experiencing pain.  The leading theory on pain is the Neuromatrix Theory.  In a crude nutshell, it suggests that the brain ultimately decides how much pain you will feel.  The brain takes in all kinds of information and then makes a decision.  With a recent injury we think that you feel pain, swelling, weakness, tightness, guarding all because the brain is trying to protect you.  The area of the injury will get more sensitive and your brain can get better at producing pain.  The brain thinks that pain is a good thing.  Unfortunately, pain can persist for a long time after the pain is useful.  For whatever reason the brain, your nerves, your muscles, your immune system, your endocrine system all stay sensitized.  Its now easier for you to feel pain.

But none of this is all in your head.  In fact, this is how athletic excellence works

The brain learns and you become a better athlete/guitar player/knitter

np_overviewIn some ways we can think of pain as habit.  Our nerves and brain get better at making pain.  Now, I know this sounds like I am saying this is psychological because I’m talking about the brain.  But would you ever say its psychological when you get stronger after working out for 6 weeks? Of course not, but after exercise training much of the reason we get stronger or perform better is because the brain and nervous system become better at the task.  This is similar to what happens with pain.  We get sensitized and better at producing pain.

Pain is neither a barometer or a GPS

The pain we feel gets out of whack with any damage we have.  The pain becomes the bigger problem than any wear and tear.  Pain is now a poor guage of how much injury there is.  Pain is also horrible for telling us where the problem is.  Where do people feel pain when they have a heart attack?  Their arm, neck, chest and back.  There is nothing wrong with their arm.  This is how we need to think about pain.  It is just an alarm that goes off.

The overly sensitive alarm

NO! Don't make me do crunches!

If a fire alarm goes off in a building we have no idea if the alarm is due to a large fire, lighter held underneath a sensor, a little bit of smoke or even some problems with the wiring.  We can even put of the fire and the fire alarm will still go off.  This is how we can think about the pain alarm that goes off in our body.  It can stay on long after any damage has healed. You can even think of pain as a cranky toddler.  The pain or response of the toddler is often out of proportion to their injury.  At an unconscious level this is what can happen with our body.  A disconnect between damage and pain and we are left with screaming joints or muscles.

Again, the pain is not in your head

You might ask why I keep talking about cranky nerves and a cranky brain when you know that there are problems with your muscles and your joints.  I would probably agree with you.  When we have pain for awhile we move differently.  We can get weaker, we can get stiffer, muscles can compensate, you might slouch or limp or move poorly.  All of these things can either be caused by your pain or can be contributing to it.  Addressing them can be helpful but surprisingly it is not often necessary.  Often, we can change your pain immediately and you will have immediate change in strength or range of motion.

Treatment is about decreasing the sensitivity of the system

You have threshold to where you feel pain.  Treatment is about increasing this threshold.  This can be done a number of ways.  Good treatment should try to address as many different factors that influence pain.

The significance of everything above means that you can have damage. You can have joint degeneration and certainly can have the normal wear and tear associated with arthritis.  Whats great is you can change the amount of pain that you feel without ever changing the amount of arthritis, wear and tear or even damage in different body parts.

Treatment helps turn down the sensitivity of our nervous system.

See here for a description of my treatment approach.  But what we need to remember is that since pain is influenced by many factors many things can influence the pain we feel.

Related Pain Links

1. Pain videos

2. painphysiotherapy.ca

 

Neurodynamic Nerve Slider Pictures – helping people with pain

Tags: No Tags
Comments: 2 Comments
Published on: March 1, 2013

Below I have created neurodynamic nerve slider pictures.  I use them in handouts for patients and now you can too!  They are strongly inspired (ahem, completely based on) David Butler’s work.

(more…)

Core stability and pain: Is it time to stop using the word stability to explain pain?

Tags: No Tags
Comments: 40 Comments
Published on: December 26, 2012

Purpose: To cherry pick a few research articles to suggest that even though our knowledge of core stability is very impressive its link to pain is poor.

Nutshell summary: People in pain have spines that function differently than those not in pain.  Many treatments can influence pain.  The spine stability model of low back pain does not explain how people have pain and takes an overly mechanical view of the pain experience.  No test has ever shown that a spine is unstable or how “increasing stability” would lead to a decrease in pain.  Thinking that our spines need more stability or control may be the completely wrong path in explaining how people have pain or how our exercises help them.   Our treatment “corrections” occur not via one specific “corrective” mechanism (e.g. improving stability) but rather through global non-specific mechanisms that our better explained by our understanding of pain neuroscience.  Making the shift from believing that “stability” is the issue with pain can thus free up to choose completely different exercise programs.  Exercise and treatment prescription thus become simpler.  We have preliminary evidence to support this view with the clinical studies that show benefits with the various exercise conditioning programs that train different schools of thought on stability or the just as effective programs that completely ignore any concepts of stability.

(more…)

This physiotherapist’s approach to treating Persistent Pain

Tags: No Tags
Comments: No Comments
Published on: October 30, 2012

Audience: Patients and other health care providers

Purpose: To explain my treatment approach to Persistent Pain Problems.

Overview of the Treatment Program:

  1. Pain Physiology Education
  2. Movement (Graded exercise/activity exposure)
  3. Manual Therapy (more…)

Fascia Science: Stretching the power of manual therapy.

Tags: No Tags
Comments: 31 Comments
Published on: October 26, 2012
Its not just fascia that is everywhere

Purpose:  Fascia is everywhere, provides a fantastic structural support for the body and has the ability to transmit force from force generating muscles.  But we as therapists tend to get ahead of ourselves and make statements about treatments and the body’s function that I am not sure make sense and haven’t made sense for the past decade that I’ve questioned it.

The fascial treatment fallacy. (more…)

Structure is not Destiny – please don’t rush to freaking out about your x-ray, MRI or ultrasound

Tags: No Tags
Comments: 5 Comments
Published on: July 22, 2012

Audience: Patients

Purpose: To highlight the poor link between the bogeymen found on imaging with pain or dysfunction.

Our current technology is amazing when it comes to viewing the insides of our body.  The problem with this fantastic technology is that we can see something (e.g. a tear in a muscle or a joint with some osteoarthritis) and assume that there is something wrong or that this is the source of our pain.  However, the link between tissue “abnormalities” on MRI, x-ray or Ultrasound is often quite poor.  Many, if not most, people have “bad stuff” on their MRIs or x-rays yet have no pain. (more…)

Peripheral Nerve Tensioner videos for that irritated nervous system

Tags: No Tags
Comments: Comments Off
Published on: April 4, 2012

Below are Tensioner videos for your irritated and sensitive peripheral nerves.

Warning: please only do this if your knowledgeable health care provider has taught these and specifically said that you should do these exercises.

Gentler “Slider” movements can be seen at a previous post here: Slider Videos

(more…)

Why do people feel stiff? Are your muscles really tight?

Tags: No Tags
Comments: 2 Comments
Published on: March 17, 2012

This article is purely conjecture. I have no hard data and would not even know how to create a study to test for it.  BUT, I consider it biologically plausible.

Tightness is a common sensation for people with pain and for athletes during training.  However, when someone reports being tight in a region I find that they often are not in terms of their mobility.  Their range of motion will be wonderful, perceptually their tissue will feel “loose” upon palpation (warning: highly subjective on my part) yet they report a sense of tightness. Main point being there are no objective signs of tightness or limits in their range of motion.  So why does the perception of tightness occur? (more…)

Nerve Slider Videos: Calming down that irritated nervous system

Tags: No Tags
Comments: 4 Comments
Published on: March 5, 2012

Audience: Patients

Purpose: Demonstrate simple movements to calm, move and make healthy some irritated nerves.
Disclaimer: Not to be done if painful. Do 5-6 to start. Always under health professional guidance.

(more…)

Persistent Pain Resources for Patients

Tags: No Tags
Comments: 4 Comments
Published on: February 18, 2012

Audience: Patients

Purpose: to provide some information about the pain experience

Why?: Understanding pain can help modify it

 

I don’t pretend to understand everything about pain.  It is incredible complex and what we know is certainly involving.  However, there is a lot of misinformation out there even from people that should know better.  This article will link to a number of information sites that help explain pain.  This is important because it helps you understand why things hurt.  Understanding why something hurts can decrease pain but can also help you function better.  Some basic concepts:

 

1. Pain is a perception.  Signals (e.g. nociception or even pressure) come from the body and the brain creates an output that we perceive as pain.  Ever heard of a soldier being shot and not feeling any pain until they were safe and out of harms way?  If pain was some absolute thing that the brain has no choice to recognize than you would have no way but to feel pain any time a tissue was injured.  We’ve all heard stories of people being injured but feeling nothing.

2. Your body does not have to be injured to feel pain.  In fact you can lose a limb and later feel pain in that limb that no longer exists.

3. Tissue injuries (e.g. disc bulges, rotator cuff tears, tendinopathy) do not have to hurt.  The body can have lots of so called “dysfunction” but this does not mean that you will feel pain.  For example, 50% of people over fifty may have a rotator cuff tear but they experience no pain.

4. Emotions, beliefs, stress, past experiences etc can influence the pain that you feel.  Pain is more than a punch in the arm.

5. The perception of pain can move around in your body and this does not mean that you are crazy.  This is a normal finding when we experience persistent pain.

6. Pain changes how we move and how we function.  Movement is often the key to resolving pain.

There is so much more than this but I will let the resources below provide better information.

Books

1. The sensitive nervous system (D Butler):  a great academic reference

2. Explain Pain (Butler and Moseley): a patient’s guide to pain

3. Painful Yarns: stories from people with pain

Websites

1. Neurotopian:  Pain for Dummies   a great site, you can read this and ignore everything I say.

 

Youtube

1. Persistent pain described with pictures

 

2. Lorimer Moseley: Tedx Talks

 3. Peter O’Sullivan explains how our fears and beliefs about our backs change how we move and contribute to the feeling of pain. 

http://www.youtube.com/watch?v=j4gmtpdwmrs&feature=share&list=ULj4gmtpdwmrs

 

 

All the best,

 

Greg

 

page 1 of 2»
Physiotherapy In Toronto
uafinallogo
TRI TREK BLOG
TRI TREK BLOG
Follow me on twitter
Follow me on twitter
3D Kinematic Analysis
3D Kinematic Analysis
Welcome , today is Thursday, April 24, 2014