Living With Chronic Pain

Physical Therapy

The numbers are staggering- a third of this country suffers from chronic pain. If it’s not you, it’s probably someone you know or care about. It’s a part of our every day experience. Something we grudgingly think has to be accepted. But that’s not true. As I’ve written for the last two years (yep, hard to believe we’ve been at this for two years!) there are so many incredible options available today that can improve our quality of life and lessen pain. Physical therapy is one of them.

I hear it all the time, “I tried a few years back and it didn’t help,” or “It just made me worse”.

I used to be like those doubters. In my case, I believed it was only important to my patients, not me. I’m a physician. I understand the physiological and medical issues involved. I exercise an hour a day, five days a week. I’ve had over two dozen surgeries in my life- what can physical therapy possibly offer me? It turned out, a lot. Having an expert at my side, assessing my specific and involved needs that took into account all areas of concern was invaluable in helping me to define a safe, comprehensive program that worked for me. It not only hastened the speed with which I recovered after each surgery or when I foolhardily moved the plant I couldn’t possibly wait for others to move, but chronic every day issues as well.

Move it or lose it.

I can’t stress that enough. I know it hurts, but the less we move, the more it’ll hurt and the less we’ll move until we stop altogether. A horrifying consequence for those of us suffering from chronic pain. The question I’m always asked is how do I get more active when those very activities make my pain worse? Sometimes, just getting through the day at work is agony, and now I’m expected to exercise? This is where a physical therapist can help. They can provide a personalized strengthening and exercise plan, that helps to manage and decrease daily pain, safely.

Physical therapy interventions treat pain in a number of ways. They can strengthen muscles and joints and help us to learn to move and perform daily activities in ways that don’t aggravate old injuries or put us at risk of new ones. They can treat inflammation and address the movements we use to try to stave off pain that then causes a cascade of discomfort in other places. For example, using my cane to decrease weight bearing in my left leg then exacerbated pain in my right arm. Limping to minimize weight bearing on that leg also caused pain in other areas I was over stressing. Things I never really thought about or addressed. Physical therapy can also re-educate the central nervous system to make it less sensitive to pain signals.

Sound too good to be true? With the right therapist, believe me, it’s not. They can do this in several ways:

Patient Education

No one can be available 24/7 to make sure exercises are performed correctly, that we move in ways that protect from re-injury, or help us to make the best lifestyle choices. But that’s OK, they don’t want, nor encourage weekly visits for life. The goal of any physical therapist is to empower us to take charge of our own recovery and learn ways to help ourselves. By educating us on our own pain issues and triggers we can learn what activities to include in our regular exercise routine and what activities and movements to avoid. A physical therapist can teach specialized techniques for everyday movement and activities, advise on safely increasing daily exercises, how to pace ourselves, and how to alter movement dysfunctions, like problems with gait or posture. Before one surgery I couldn’t walk normally. They had me using walking sticks to retrain my body and relieve excruciating pain. To this day I occasionally picked them up to ensure I’m still walking normally.

Exercise

Some physical therapy exercise is passive, meaning the patient just relaxes while the physical therapist moves or stretches one or more body part. Some is active, meaning the patient has to do it under his or her own power. All exercise can be valuable for strengthening muscles, improving flexibility, increasing joint mobility, and strengthening the muscles around weak, painful joints to increase joint stability.

Manual Therapies

Manual therapies, also called bodywork, include hands on treatments such as massage, which eases pain and promotes healing by helping muscles relax and boosting circulation. Soft-tissue mobilization may be used to increase mobility around a joint by breaking up scar tissue, releasing tension, treating edema, and addressing myofascial adhesions, or fibrous areas of muscle tissue that have lost their elasticity. Direct manipulation of joints can be used to restore alignment and improve functioning. 

Transcutaneous Electrical Nerve Stimulation

Transcutaneous electrical nerve stimulation, or TENS, uses low-voltage electrical currents to stimulate an injured or painful area for pain relief. The electricity is administered through electrodes attached to your skin. It’s thought to relieve pain by intercepting  pain signals from the nerves in that area, lessening the sensation. The electrical stimulation may also boost the production of endorphins, neurotransmitters which serve as natural painkillers.

Hot and Cold Therapies

Hot and cold therapies include the application of heat or cold to the painful area to reduce inflammation, relieve pain, and promote healing. Hot and cold therapies can include:

  • The use of hot packs to deliver moist heat to the painful area, to increase circulation, relax muscles, and relieve pain;
  • The use of hot or cold whirlpool baths to improve circulation and control swelling or inflammation;
  • The use of ultrasound to apply deep heat to muscles, bones, and tendons;
  • The use of ice packs to limit swelling and ease soreness.

Graded Motor Imagery

Graded motor imagery, or GMI, is a chronic pain treatment that uses your brain’s own plasticity and neural connections to treat chronic pain. The therapy uses techniques such as visualizing movement without actually moving, using mirrors to trick your brain into thinking that you’re moving a weaker or painful body part when you’re actually moving a stronger body part, and using left-right discrimination exercises to recalibrate crucial parts of your brain that help in pain recovery. GMI helps patients to regain confidence in their physical strength and relearn motor control, while reconfiguring responses to pain.

Sensory Re-Education

After a serious injury or illness, chronic pain can occur when the nervous system is overwhelmed by constant, severe pain signals, that go haywire and continue to sense pain even after the injury has healed. Sensory re-education for chronic pain can help desensitize the nervous system to these pain signals so that they are no longer overwhelming. The re-education protocol usually uses light stimuli on both the unaffected and affected areas, so that the brain can begin to compare sensations in these two areas and decrease sensitivity in the affected one.

Physical therapists have a multitude of treatments available to better manage chronic pain and acute exacerbation by increasing strength and mobility. They may not make the pain go away but they can definitely impact how that pain affects our daily lives. I know first hand how much they have helped me and my patients.



Sources:

-ncbi.nlm.nih.gov/pmc/articles/PMC5498791/
-emedicine.medscape.com/article/310834-treatment?src=ppc_google_rlsa-traf_mscp_emed-hdle-cohort_md_us
-rehabpub.com/pain-management/chronic/physical-therapy-can-treat-chronic-pain/-verywellhealth.com/pt-for-chronic-pain-4179087
-everydayhealth.com/pain-management/physical-activity-and-therapy.aspx
-spineuniverse.com/conditions/chronic-pain/physical-therapy-chronic-pain
-psychologytoday.com/us/blog/chronic-pain-360/201507/the-role-physical-therapy-in-treating-chronic-pain

-main image courtesy of:google.com/url?sa=i&url=https%3A%2F%2Fwww.mdbonedocs.com%2Fbenefits-of-physical-therapy%2F&psig=AOvVaw2t4nm1vk_SUAT1FcbpS3A1&ust=1597458459290000&source=images&cd=vfe&ved=0CAMQjB1qFwoTCOjo79PSmesCFQAAAAAdAAAAABAD

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