CHRONIC PAIN AND ACTIVE REHABILITATION
Most of us have had the experience of having a paper cut feel like it’s a “Centre of our universe” pain, while we may have broken a limb or severely injured ourselves in another circumstance and not noticed until later on. How can something as trivial as a paper cut be so huge, when something as damaging as a break could happen without our awareness?
What this tells us is, pain is a rich, complex experience. Pain involves not just the physical experience of some injury (or threat of some injury), but pain also involves processing stimuli from various inputs, including social, psychological and physiological experiences.
Pain is Interpretation
While pain is a brain signal, it does not necessarily tell us what is wrong. All we know is that our brain thinks something threatens our body’s balance homeostasis.
In other words, pain is cognitive: it’s an interpreted event in which the brain takes in multiple signals – including physical, social, psychological input – and then decides whether the combined output says “pain.”
At its most fundamental level, we can say that:
- Pain is an action signal
- Pain a signal to change
- Pain is indicative rather than diagnostic.
- Pain is the brain telling us that something is threatening our homeostasis; it doesn’t tell us specifically what is wrong.
Acute & chronic pain
Generally speaking, pain breaks down into two categories
According to the International Association for the Study of Pain (IASP), acute pain is generally associated with an injury (or anticipated injury) and is site specific. The sufferer can usually show exactly where the pain is, and what triggers it. The pain is sharp and clearly defined. If there has been tissue damage, there can be swelling or later scarring.
Chronic pain is more like the nonspecific shoulder or backache that’s been around for a year. Chronic pain is ongoing and tends to be more diffuse. Chronic pain intensity can come and go and is not always associated with specific events.
Sufferers of chronic pain often reduce their movement (to reduce pain), and fear the types of movements that seem to stimulate the pain, although it may not be a specific movement that induces the pain. Although chronic pain may be accompanied by inflammation, there may be no physical signs that there is any particular tissue repair work going on.
Managing pain with movement.
Pain-free movement can be a way to accelerate healing and break chronic pain cycles. Movement we know is a key part of health. Because of how we’re wired, movement — though again, not into pain — actually plays an important role in pain management.
We are designed as “use it or lose it” systems, our bodies adapt to the demands — or lack of them — they experience. If we don’t move something for a while, our bodies begin to adapt to support that lack of movement. Unused bone disappears. Unused muscles atrophy.
Here’s a common example. Your back hurts. So you go to bed. After a few days of lying around, you feel worse. Now your shoulders and neck hurt too. Your hips hurt from the pressure of lying down. Not a great solution. This can create a vicious cycle. Compensating for one painful movement induces other restricted movements. Even if you have a medical condition like osteoporosis or heart disease, movement and exercise are a key component of recovery.
By staying as mobile as possible, at every joint, without pain, we signal two things. First, movement says we are still using this part of our body and thus this body part needs resources for healing and growth. Second, the movement signals themselves can overwhelm a pain signal to say there’s more right than wrong going on in the area: there are more nerves that tell the body how we’re moving than nerves that say there’s something wrong.
Movement nerves (mechanoreceptors) are also easier to turn on than nerves that trip in the presence of noxious stimuli. This receptor ratio is used to great effect when we drop a weight on our thumb and then shake and rub the area and find the pain is reduced.
Movement for pain management.
the benefits of movement and pain management are as follows:
- Helps turn the ‘pain volume’ button down by accessing the nervous system.
- reassures you that some pain with movement is safe and comfortable.
- Assists in the healing process
- Keeps you active, strong and capable of doing what you want to do.
- Regulates sleep patterns.
- Reduces stress and Improves mood and mental health.
- Improves immune function (your body’s ability to fight infection or illness or stress)
- Excellent for your general health (heart, lungs, muscles and joints)
- Helps with weight control
- Manages additional chronic disease like diabetes or heart disease.
- Helps maintain a healthy brain as you age
What if it hurts when I move?
Sometimes, pain gets in the way of movement and exercise. We may respond to pain by: stopping moving, move differently or move excessively.
It is important to be aware of the factors that can influence your decision to move when you feel pain:
- your beliefs: If you have helpful beliefs (some pain is a normal part of recovery and does not mean harm; it is safe to move), it is less likely to experience ongoing pain. Unhelpful beliefs (hurt equals harm; damage), it is likely recovery will be slower and pain is persistent.
- Consistent guidance and instruction from your physiotherapist to start moving and exercising in an appropriate paced way is key to support recovery.
- Negative thoughts and low mood responses to anticipated or actual pain, mean that we tend to magnify the threat value of pain and can feel helpless in pain management.
- Fear of pain or causing damage: Remember that some pain is normal when you are recovering and does not mean damage. It is important to discuss this fear with your physiotherapist and create safe strategies to help you get moving again.
- In some conditions, pain can be associated with distortion of our perception of where our body is in space. Movement activates the body’s natural neuroplasticity and helps treat pain in such cases.
What is the right type of exercise for you?
Exercise must be specific to each person and their specific needs. A good exercise plan usually requires a balance of 3-4 main types:
- Cardiovascular exercise (walking, cycling, swimming)
- relaxation and flexibility (yoga, tai chi, Pilates, stretching, breathing)
- Strength and endurance (Pilates, resistance with weights)
- balance and agility (yoga, Pilates)
Finding the best exercise for you
Your physiotherapist will guide your exercise choices:
- Exercise like walking, cycling or possibly swimming can be done by most people and improves general health and function. Walking is easy, free and can be done anywhere, anytime.
- Muscle relaxation techniques and a stretching program is vital if if you experience stiffness, tightness and pain in your movements or experience stress, anxiety or distress.
- Exercises can be modified to your individual needs. You may need to strengthen certain muscles,re-educate your body for optimal movement or create flexibility in stiff muscles.
- Balance – your physiotherapist will assess your balance and guide you through appropriate exercises. This is very important if you have osteoporosis and are at risk of falling.
Physiotherapists are exercise specialists and have comprehensive knowledge of injuries and chronic diseases. At PhysioCare, we provide one to one active rehabilitation in our Carrickmines & Blanchardstown Clinic where we will work closely with you to improve your function so you can live life to it’s fullest.