Breaking the cycle of chronic pain. What is chronic pain?
Upto one in five Canadian adults suffer from chronic pain. It affects one in five people globally and is the primary reason people seek medical treatment. In most cases, chronic pain starts with an acute injury or illness. Sometimes, what can happen, is that even after you’ve healed from an injury, surgery or other conditions, the pain continues. If the pain lasts longer than 3 months it’s then considered chronic pain.
Chronic pain syndrome can then be considered short term pain, or acute pain, that doesn’t go away and has a physical and psychological impact on a person’s life. Chronic pain syndrome often creates secondary complications such as sleep deprivation, depression, irritability and fatigue, affecting a person’s personal and social relationships.
What is Pain?
Pain functions as a warning signal. The nervous system senses danger and responds to it with actions called guarding responses, designed to protect and defend us from further injury or harm.
Muscle tension, decreased range of motion, anxiety, fear of movement, increased sympathetic responses (raised heart rate, increased blood pressure, change in respiration) and a mechanism called low pain threshold (becoming excessively sensitive to pain and minor impulse or stress to the body region cause pain) are all consequences of the guarding response. This is the way the body protects itself from future painful incidents.
In chronic pain, even after the injury has healed, this mechanism remains and continues to affect the body creating a vicious cycle of real pain.
Your Brain and Pain
When we adopt this instinct to guard ourselves against future pain, it actually does the opposite and keeps feeding your pain cycle and increasing symptoms including pain (scientific research “Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and behavioral Pathways). This guarding mechanism is most likely to occur to those people that view their pain or condition as a threat, rather than something that just is and that in all likelihood can be overcome or at worst worked through towards acceptance and continuing on with life in as normal or your new normal way as possible.
Being extremely apprehensive about your injury and symptoms, avoiding activities believing that that may be harmful, stress and negative emotions are coupled with autonomic, endocrine, and immune responses which may amplify pain through a number of psychophysiological pathways prolonging your “fight or flight” response to the original injury. This will lead to a downward cycle of deconditioning, weakness, muscle spasms and/or tension, increased anxiety and depression.
What can Saanich Physiotherapy and Sports Clinic do to help reverse pain?
Part of our job as physiotherapists and massage therapists is to help you and guide you, our patients, to overcome any fear avoidance behaviour (learned fear), such as fear of movement, by using not only hands-on treatment, dry needling or exercises, to target your injury or pain, but to talk to, explain and assist you in understanding the way that pain and our brain works. We can help you to overcome or negate some of these non-helpful brain responses. By doing this we help you to down-regulate your brains protective response in order to minimise your pain experience.
Working with you in this 1:1 way, taps into your brain and nervous system. Your brain and nervous system is complex. We can work with you to change your neural pathways and learned patterns of thinking and beliefs that in turn produces more of your own natural brain chemicals like endorphins. This resetting and rebalancing, forming positive neural/brain connections, plays a large part in you overcoming your injury or pain experience.
Of course, each individual person is unique and we all come with our own history and life story that also plays a major part in how we experience pain and how we as therapists target your particular treatment. The way we think about our pain and ourselves, how we act and what kind of self-talk we undertake can all play a major role in the way that our Physiotherapists work with you, our patients who suffer from injury, pain, chronic pain, pain sensitivity, learned fear, anxiety, and depression.
What is it?
Hip bursitis is a fairly common condition, and involves inflammation of the bursae around the hip joint. The bursa are small fluid-filled sacs, and are present to reduce the friction between tendons and the bone and ensure that everything is able to move smoothly. However they can become inflamed and painful with overuse, trauma and incorrect muscle use or weakness. There are many, however the bursitis we most commonly see is the Trochanteric Hip Bursitis. The trochanteric bursa cushions the outside of the hip against the gluteal muscles (especially gluteal maximus) and the Iliotibial Band (ITB). It is the most commonly injured as these are muscles very commonly used and therefore give the bursa a lot of work!
What are the causes?
As mentioned earlier, there are a few key causes of bursitis:
Overuse (or muscles around the area) and repetitive stress – eg. With frequent running, jumping, squatting
Trauma – e.g. a fall directly onto the outside of the hip (where there isn’t much padding)
Incorrect muscle use and muscle patterns, causing altered biomechanics of the lower limb – this can also include weakness of the core muscles
Weakness in the deeper gluteal muscles (Gluteus Medius and Minimus), and tightness in the Iliotibial Band (a band that runs down the outside of the thigh). As a result of the weakness in the deeper gluteal muscles, the gluteus maximus (biggest gluteal muscle) is forced to work more than it should, and so places more pressure in the bursa, which over time causes irritation and inflammation, and pain.
Interestingly, there are recent studies to suggest that hip bursitis does not often occur on its own, and that there is commonly some element of Gluteal pathology – especially tendinopathy of the Gluteus Medius (the main stabilising glute muscle). This may be the causative reason for weakness in this area, however it is not known yet as to which comes first – the bursitis, or the tendinopathy.
What are the signs and symptoms?
Commonly, sufferers will have a sharp pain on the side of their hip (worst directly over the bony outer part of the hip, and often tender to touch). This pain may extend down towards the knee, or even upwards towards the lower back. In fact, as the lower back, hip and knee are so closely linked, it is not uncommon to see problems in all areas along with hip bursitis, including pain, stiffness and restricted movement of these areas.
Sometimes there will also be a visible swelling over the outside of the hip, or even just the feeling of swelling.
There is often difficulty lying down on the side (due to the direct pressure), or even on the unaffected side (due to the stretch). This may cause trouble with sleeping.
Walking is also aggravating, especially first thing in the morning, or after a busy day. A limp may be present. There may also be pain with sitting cross-legged, or rising out of a chair after sitting for a while.
What are the treatment options?
There are several options when it comes to improving pain and keeping the bursitis away.
Physiotherapy – this is highly successful for treating trochanteric bursitis. Initially, treatment will involve techniques to reduce the pain and swelling (eg. Ultrasound, ice, gentle massage, acupuncture, taping). Following this, your physiotherapist will aim to return full range of motion of the affected hip (and also lower back, knee if affected), correct any muscle imbalances around the hip and restore full function of the stabilising hip and core muscles, and work to eliminate any excess tightness that may be contributing to the problem. Due to the nature of trochanteric bursitis, and the danger of it recurring, a long-term program may be required.
Ice – due to the inflammatory nature of trochanteric bursitis. Ice for 15 minutes at least once per day, and also after aggravating activities
Cortisone Injections – this involves injecting a corticosteroid (anti-inflammatory) along with a local anaesthetic into the bursa in order to settle the inflammation and stimulate healing. A guided injection (usually via ultrasound) is preferred as it will assist with needle placement. Cortisone injections can be very helpful, however repeat injections have been shown affect tendon health detrimentally – it would be wise to discuss side effects with your GP.
What can I do to help?
If sleeping is a problem, it can be improved in the short term with a pillow between the legs, to level out the hips when laying on the unaffected side.
Driving can be aided by sitting slightly higher (so your hips are not as bent). This may involve lifting the seat (in newer cars), or simply sitting on a pillow. Do make sure you can still reach the pedals & drive safely however!
There are several helpful exercises that will assist in recovery and strengthening. These will ideally be performed after the initial healing phase is completed (that is, when the pain and swelling have diminished). These exercises should be performed within your comfort levels, without causing pain.
Seated gluteal stretch
Sit on edge of chair, cross one foot over the other knee, SIT UP TALL, and lean forwards
There should be a comfortable stretch in the buttocks, or even down the side/back of the leg
Hold 20 seconds, repeat 3 times each leg
Lying gluteal stretch (Single knee to chest)
Lying on your back, slowly bring one knee up towards the opposite shoulder as far as comfortable.
You should feel a gentle, comfortable stretch in your lower back, or buttocks
Hold for 10 seconds, repeat 5 times
Start on your back with knees bent (no pillow is best)
Slowly roll pelvis/hips off floor, followed by one vertebrae at a time
Aim to lower down, one vertebrae at a time
Try 10 repetitions
Prone Knee Bend
Start by lying on your tummy, feel the front of your hips on the floor.
Bend one knee to 90 degrees and then slowly lift thigh off floor (the front of your hips should stay firmly on the floor)
Once lifted, straighten your leg in the air, then slowly lower your straight leg
Repeat 10 times each leg
Start lying on your side with knees bent slightly. Make sure your shoulders, hips and feet are in a straight line.
Keep your feet together, back still and gently open your knees apart.
Repeat 10+ times on each leg, or until fatigue
* This exercise is especially helpful as it targets the Gluteus Medius
As above, make sure your body is aligned well.
This time, lift your feet up, keep your lower knee on the floor and lift your knees apart.
Repeat 10+ times on each leg, or until fatigue
Are our devices giving us neck pain?
There are millions of people right now looking down at their smartphone or tablet. Do you ever stop to think about what this might be doing to your neck and upper back?
At Saanich Physiotherapy and Sports Clinic, we are seeing a huge increase in the amount of neck, upper back, shoulder and arm pain which is all related to posture when using devices. From texting on the smartphone to watching TV on the tablet in bed, we are all guilty in some way. And sadly, we are seeing more and more children coming in with these issues too.
Consider how much your head actually weighs. On average, it weighs 4.5-5kg. When sitting or standing upright, this weight is supported by the lower neck vertebrae, intervertebral discs, muscles and ligaments. When you then lean your head forward when looking at your smartphone, the relative weight of your head on your neck muscles can increase up to 27kg! Just by looking down at your phone, you can increase the force on your lower neck by 5 times!
When maintaining this position for a period of time, the muscles will fatigue and stop working, meaning that the force of your head is now being held up by small ligaments, the neck joints and the discs in the neck. It is no wonder people are having more and more neck pain.
The term “Text Neck” is becoming more commonly accepted as a diagnosis for neck pain caused by prolonged use of smartphones and tablets. If left untreated, this massive increase in force in the lower neck and lead to headaches, increased arching of the spine, general pain and tightness and arm pain from irritating nerves in the neck. It can also cause weakening of the muscles in the neck which can lead to ongoing pain, stiffness, headaches or arm pain in the future.
With the increase in children having smartphones and even the use of tablets in school, there are becoming more and more postural issues arising which is definitely a concern for ongoing and long term neck and upper back problems later in life.
Text Neck can be treated. Your Physiotherapist may use joint mobilizations, soft tissue massage, taping or even dry needling to help restore normal movement within the joints and muscles.
However, it is imperative that you strengthen the muscles in the neck and upper back to prevent long term issues. Your Physiotherapist will tailor a program for you to complete at home or might even recommend core conditioning or yoga classes for a supervised strengthening program.
If you, your children or another family member or friend are guilty of using their smartphone or tablet too much and are noticing pain or discomfort in their neck, upper back or arm make sure you book an assessment with your Physiotherapist sooner rather than later!
Back Pain solutions with Saanich Physio
Back Pain Victoria – Back pain or back injury is a very common condition that we treat on a daily basis. Saanich Physio has a particular interest in treating your back pain by providing quality, effective hands-on Physio & exercise solutions for your back pain.
Back Pain Physio
Once we have your acute back pain under control with hands-on treatments we work with you to rehabilitate and restore the function of your back muscles and spine. All our Physiotherapists will work with you on exercises for your back pain, as we believe self -management strategies are key to the prevention of recurrent back pain episodes.
At Saanich Physio our approach to your back pain is holistic and your back pain physiotherapist will work with you on improving areas such as posture, sleep, lifestyle, work ergonomics, stress reduction, hobbies or your current sports or exercise regimes. We may also discuss the impact of additional factors like heavy schoolbags, lack of exercise or a sedentary lifestyle.
Back Pain – What causes it?
80% of the Canadian population will suffer from back pain at some point during their lives. It is the third most common reason people take time off work after colds and flu. Lower back pain can originate from many causes. Your back pain can originate from your lumbar spine discs, spinal facet joints, arthritis, back muscle strain, back ligament strain, muscle spasm, bony spurs or growths, pinched nerves, irritated nerves, osteoporosis, sciatica and stress just to name a few.
Back Pain – why do I have it?
Some of the most common reasons for back pain are incorrect lifting techniques, repetitive bending, poor posture, prolonged sitting as well as weakness in your core stabilising muscles
Back Pain Victoria – Signs and Symptoms
Back Pain can affect the lower, thoracic or middle back or upper back neck.
Back Pain is often described as one or more of the following:
- Local sharp pain, dull ache or burning pain
- Pain that radiates into your hip, groin or buttocks
- Pain that is aggravated by sitting, standing, bending forward or backwards, twisting or walking
- Pain that travels down your leg to your thigh, calf, ankle or foot
- Pins and needles or numbness travelling into your legs and /or feet
- Weakness of your leg muscles
- Pain associated with loss of bladder or bowel control
Back Pain Victoria – Will Physio help me?
Hands-on Physio treatment for back pain will vary according to the cause of your back pain. In addition to soft tissue techniques and joint mobilisations, we may use dry needling for back pain, taping or bracing to support your spinal muscles, heat or ice therapy and suggestions for medications for reducing your pain and inflammation. Your back pain Physio may refer you for appointments for x-ray, CT scans or MRI to assist in diagnosing your back pain if required. We can liaise directly with the radiologist for scans and or steroid injections.
Non-Specific Back Pain
Degenerative Disc Disease
Stiff Lumbar Joints
Discogenic Back Pain including-
Bulging Disc, Prolapsed Disc & Herniated Disc
Spinal Canal Stenosis
Thoracic-Upper Back Pain
Sacroiliac Joint Pain
Back Sprains and Strains
Pregnancy-related Back Pain
Physiotherapy to prevent relapses and worsening of symptoms
Make a booking today to get your back pain under control. Click our Book Now Button for an appointment today.