Persistent pain...how to deal with all the junk.
Chronic pain - Now known as persistent pain is very common. In fact in Australia - 1 in 4 have been diagnosed with it and quite possibly the same statistic in the US. Two of my favorite videos are below…
So what is it?
Some will define it as pain that lasts longer than 3 months - Usually by this time we have either forgotten about it or the tissue has been able to heal and is better!
But what happens when “they can’t find anything” and you still hurt?
It can be the kind of pain that keeps you from picking your own family members up; Keeps you from doing your favorite sport or race?; Wakes you up at night; Keeps you from traveling; or has you scare to do any of the above due to the flare up you’ll experience afterwards.
I mean - I hear it all the time - “I’ve had pain since like high school”. “I got into 6 car accidents and never got treated or saw anyone who helped me with things” and my most recent favorite “I just thought I was going to be broken and nothing could change” - it hurts my heart to hear these things. These people have lost hope - hope of anything better than the baseline of pain they’ve lived with so long.
Let’s shift perspectives…shall we?
So the problem is not usually the initial injury though some things the body just cannot remend. But the problem is the compensation patterns that creep up over and over and over with every single step, twist, reach or every second of sleeping.
That’s when you need to find a provider that understands the complexity of the nature of pain.
Where DO I START??
Generally, when we see patients in the physical therapy clinic, we have been taught to treat the tissue at hand - tendon, muscle, bone, joint, ligament and even skin/scar and all tissues have a different healing pattern and timeframe (thus the rationale behind a doctorate degree in PT!) But we know (read previous blog) that the problem is really the brain. The brain (central nervous system) gets sensitized and so do the peripheral (nerves in that region) nerves.
The problem with persistent pain is that we have a hard time working our way out of it because its so deep rooted it’s hard to recognize and it hurts!!
So here are some of the best treatment options out there:
According to a study from the Journal of Women’s Health Physical Therapy ( I can give you the article if you want..)
Connective tissue mobilization - working through the tissue around the site of pain can help to mobilize those tight structures and decrease the nerve sensitivity. It can help to interrupt the reflex or arc the brain and tissue’s communication. Massage and soft tissue mobilization often help - I love the towel roll and foam blocks for self release as well as the Coregeous ball ( no kickbacks associated with this recommendation)- I have had good success with dry needling too because it can break the pain cycle quickly.
Deep breathing - we always start here. Breathing is essential to every day life. In fact, if we go by basic breathing rates of 14/minute, we inhale and exhale up to 840x an hour. This is multiplied by 24 for a full day to 20,160x a day. If we are breathing shallowly or using improper muscles or patterning, we can feed into the pain and body’s nervous system wind up. Not to mention the poor oxygen consumption with shallow breathing!
Relaxation training - This is similar to the blog I wrote a couple times ago where we can scan the body and go through progressive muscle relaxation, autogenic training, mindfulness training, or meditation. The goals to all is to increase relaxation of the body and improve our attention, emotional state or regulation and mental flexibility
Cardiovascular Exercise - We are encouraged to exercise 150 minutes at a moderate to vigorous rate by the American College of Sports Medicine but it is proven to also increase our stress response, improve mode and reduce anxiety as well and reduce depression. This amounts to moderate intensity training at 30 min a day for 5 days or vigorous activity for 20 minutes 3 days a week and recommend strength training as well.
Guided Imagery - This includes individual exploration of belief patterns and movement patterns that may not be helpful in return to normal patterns and function. (Please see previous blog post). This also allows you to see how much control you do or do not have over your through, beliefs and movements - all of which are helpful to know and work through. My favorite to do with patients is to do a color relaxation where you are imagining a peaceful scene - sensing the surrounding senses of temperature, smell, sound and picking a color that resonates with you. On the inhale, you’d pull that color into your body as if it were a smoke or chalk substance and allow that color to relax everything it touches. I start in the face and talk through the whole body with special care to note the parts that generally try to draw your attention in a negative way.
Yoga - Speaking of movement patterns and fears, Yoga can help promote mid-body awareness by helping you with breathing techniques (#2), body map training (3), increase awareness of mental and physical states (#5) and help understand their pain response. Yoga also “can decrease sympathetic nervous system activity, reduce inflammatory markers, reduces stress markers/cortisol, and increase flexibly, strength, circulation and cardiorespiratory capacity” as well as “increase frequency of positive emotions” thus leading to “self efficacy for pain control
Affirmations or positive thinking - thoughts are nerve impulses just as movement and motor patterns are nerve impulses. “Negative thinking alone can drive persistent pain states.” One study demonstrated that even the thought of movement for one group of individuals could provoke pain. So it all starts with your mind and your anticipation of the thought of an activity. The more positive the better the outcomes. Gratitude journaling has become really popular - there are a lot of cute options on amazon.
Joy and Laughter - When we see positive picture, hear beautiful music taste yummy food or even smell sweet tastes, we have a reduction in the pain according to one study that used MRI for testing. Trying to keep yourself around positive people, environments and writing lots of sticky notes can and will go a long way!
Sleep dysfunction - we all know how much sleep can affect our mental state and healing. Stress decreases our immunity and thus affects our pain and stress hormone levels. Sleep and exercise together have been researched extensively and found to five the best outcomes for mood, quality of life, depression, insomnia, and resilience to stress. More on sleep suggestions later…
Not sure where to start?
Get assessed and a jump start!
Physical therapy can address and bring all of the listed suggestions in one session! Try it - or find something you know you love…and be consistent!