All Posts tagged Pain

Motion is lotion

Motion is lotion

Understanding the “Why” behind Movement & Exercise

How do our mindset and beliefs around exercise affect the decisions we make? This blog explores the nitty-gritty of the “why” movement and exercise are beneficial to you in order to help you make the change you are seeking.

As Physiotherapists, one part of our job is to provide evidence-based education to our patients about the importance of movement and exercise. Movement can be active (something you do) or passive (something that is done to you such as joint mobilisation or muscle/nerve/fascia release as common examples). Saanich Physiotherapy  and Sports Clinic prides itself in providing an engaging holistic approach to your health & wellbeing. Movement and exercise are but one part of that approach.

We are each of us unique. We come with complexities and intricacies that make us who we are. In order to delve deeper to understand the “why”, it is important to highlight that all injuries are not the same, even if they are the same injury. Equally so, all pain is not the same, despite the pain seeming to originate from a particular region. Confused? It’s ok, it’s a little bit complex, but I promise to break it down for you so it’s easy to digest. No-one likes pain and our brains are wired to take short cut’s. It’s part of being human. We all want a quick fix. We don’t have time for this pain or injury. It’s stressing us out. Sometimes a quick fix can work to provide some temporary relief, and that’s ok. However, there is usually more to the story and so I will tell you about what we’ve learnt from the many 1000’s of patients we have had the pleasure of helping by getting to know their stories around exercise and movement.

If you’ve tried quick fixes and you haven’t solved the issue your internal voice may speak up and tell you to “do exercises to fix the issue”. That seems logical. Then you probably google it.

Movement and exercise to fix an issue

If logic has taken you on a bypass route straight to a Dr Google search or an Instagram video providing a generic or formulaic approach to exercise as a “fix”, the bypass route will not provide all the answers you need and may even steer you in the wrong direction. There is nothing wrong with information however, which information is critical. Which exercises? When to do them? How many to do? How often to do? When to increase? When to decrease? When to change? What if I get worse? Do I persist? Do I modify? How should I modify? These and many more questions will not be answered by trying to skip the longer scenic route with your physiotherapist as your co-driver and guide to improving your skill. Heading straight to the bypass route either solo or with only partial information that applies to you specifically will often lead to an aggravation of your pain and a delay in the healing process.

Please don’t stop reading here as there is so much more to share with you. Your Physiotherapists job is to know people and people are like complex ecosystems. Bodies – brains, hormones, muscles, bones, tendons, ligaments, nerves, fascia, neural networks, chemicals transmitting signals everywhere, emotions, expectations, histories, unconscious and conscious biases and everything that makes you tick, it’s all interacting with your environment, with other people, constantly re-evaluating. How amazing is that? People are awesome. You are awesome and that is why you need a multifaceted and complex problem-solving approach to your treatment. That is what we do. There are no exceptions. None of us can say we are exempt, we don’t get to opt-out, as we are all made up of the same pieces, it’s just that our jigsaw puzzle, once completed, like our neural networks and their interconnectedness, looks different to anyone else’s. And that is the beauty of people and everything each of us brings with us.

Mindset and Beliefs

Before we look at the “why” exercise is important, it is imperative to understand the mindset and beliefs we each carry within us in relation to movement and exercise. Simply hearing the word “exercise” can invoke a range of varying emotions and responses in each of us. These responses are based on our subconscious and conscious biases, our way of thinking, our past and recent experiences.

We all know exercise is supposed to be good for us – but “knowing” is simply often not enough to make the leap to effect a change in our behaviour, specifically around learning and developing new patterns of behaviour. In order to learn and lay down new habits, we must “do”, we need to act and we must “repeat”. Another vital link to laying down new patterns of behaviour is attributing a positive meaning to our new “doing”, in this case, exercise. Here we explore a range of common responses to exercise prescription or even the thought of doing exercises and the likely mindset linked to each.

This could be anything from:
*a closed mindset response – I am not doing that
*a negative mindset response- I don’t want to do that
*a stress response – I don’t have time
*a fear response – I can’t do that
*an avoidance response – that doesn’t apply to me
*an unsure response – I didn’t know that could help
*an angry response – I don’t want exercises. I just want someone to fix me
*a curious mindset response– how will that help me, can you tell me more so I can understand?
*an open mindset response – I will do my best to execute that
*an eager response – what can I do to help myself
*an overeager response – If I just do a lot of these this should fix my issue
*an honest response – I may not have the time, nor energy, but I understand that this can help me so I’ll give it a try
* a mindful response ­ I will tell myself I’ve done a good job when I do my exercises, even if it’s not as often as it could be, I am doing the best I can at this moment.
*a non-judgemental response – I will not tell myself off if I don’t do my exercises as this is not helpful to me learning new patterns of movement and exercises.

Exercise prescription – Finally the nitty-gritty of why exercise and movement are good for us

Exercise prescription can be given for a range of reasons too. The majority of the physiotherapy patient population are prescribed exercises for improving the functionality of a muscle – it may be weak, lacking endurance capacity or overactive and tight. A muscle can also be slow at responding to input from our immediate surroundings which can affect our sense of balance and lead to issues such as falling over.

However, exercise can be given for other reasons too, such as pain modulation, down-regulating an overactive and sensitized nervous system, improvement in bone density, decreasing stress hormones (ie cortisol ) and substance p ( a neurotransmitter & neuromodulating chemical responsible for providing information back to our central nervous system about pain sensations in the body), to minimise and manage the inflammatory chemical response to acute injury or chronic stress on the immune system ( there are many inflammatory mediating chemicals that are produced inside our bodies such as histamines, prostaglandins and bradykinin – this one increases the bodies sensitivity to pain).

Exercise and diet may also assist in the management of overproduction of pro-inflammatory hormones (such as insulin and eicosanoids). An overproduction of these hormones can lead to chronic hyperactivity of our immune system and the development of immune system disorders (including but not limited to rheumatoid arthritis, Crohns’s disease, asthma, ulcers, cancer, atherosclerosis {heart disease}, sinusitis and more ).

Exercise decreases the levels of TNF (tumour necrosis factor) and CRP (C-reactive protein), which are both involved in systemic inflammation. In order to maximise the benefits of exercise and avoid chronic inflammation, we need to ensure we allow sufficient time for your body to recover after each strenuous exercise session.

Foods that increase the inflammatory response in our body are sugars, refined carbohydrates, saturated fats, trans fats, omega 6 fatty acids, MSG, gluten and casein (arthritis.org ).

Exercise can help us to get to sleep (when we get into a regular morning exercise routine our brain produces a sleep chemical called melatonin and exercise also stimulate the brain to produce a chemical called adenosine which makes us feel sleepy). Your circadian rhythm (your natural sleep/wake cycle) is maintained with regular exercise and therefore your sleep patterns are maintained consistently. This is very important in the management of pain and mental health stability.
Exercise regulates our mental health by reducing the body’s arousal, anxiety and depressive symptoms (after exercise our brain produces endorphins, dopamine, norepinephrine, and serotonin and these chemicals make us feel happy and improves our sense of wellbeing ).

Exercise helps our brains remain engaged. As we age, our brain needs to keep learning new things to keep it active and exercise can play a major role in keeping neural circuits in our brain open or creating new neural circuits. By engaging in exercise, we effectively slow down the process of ageing. Working on proprioception, which is your brains understanding of where you are in the world, you can improve your balance reactions, allowing you to do more for yourself and prevent falls.

So that is my condensed version of the nitty-gritty of why exercise is good for us. For me, I enjoyed sharing with you my passion for moving and I hope you learned a few new things too; and now both you, who has most likely sat for a length of time to read this article and me, as I have sat for a lengthier time to write this article, need to get up and move.

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Treating Chronic Pain

Treating Chronic Pain

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.

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Explain Pain Therapy

Explain Pain Therapy

Do you suffer “Chronic Pain”?

Do you feel misunderstood and frustrated?

Here at Saanich Physio we want you to remember, the concept developed by Mosely and Butler (2017): All pain is normal, all pain is a personal experience and all pain is real.


The International Association for the Study of Pain (IASP) has classified chronic pain as “pain that persists or recurs for more than three months” (which is longer than the expected healing time of soft tissue), with the exception of pain experienced after some surgeries and some types of traumatic injuries (International Association for the Study of Pain, 2016).


To understand chronic pain, we have to understand why we can have such intense, debilitating pain, when health professionals classify our tissues “normal”.



First we will explain a little bit about inflammation and the nervous system.


Inflammation
Inflammation is the body’s amazing, natural, healing process whereby blood flow to a site of injury is increased and chemicals are released into the area to start healing. Symptoms of inflammation include pain, redness, swelling and heat in the area.


The Nervous System
Nerves originate in our brain and spinal cord. There are two types of nerves.


Sensory nerves: Detectors which help us to understand what is going on around us and keep sending messages, or inputs, to the brain and spinal cord, to make us aware of our environment and inform us whether it is safe or potentially dangerous. Sensory neurons have input in to the brain and spinal cord.


Motor nerves: Action causers, which cause us to move, by activating appropriate muscles or glands to release appropriate hormones. They also cause the spark of thoughts, behaviours and beliefs. Motor nerves are responsible for causing our actions based upon the brain and spinal cords calculations and are outputs.

It is hard to believe that pain is actually generated in the brain and is an OUTPUT released when harm is detected.
Basicially, when danger is detected, the brain and/or spinal cord send pain to that area, so in turn we protect the threatened tissue by changing our behaviours or positions, for example by limping to reduce weight bearing on a potentially broken foot (Littlewood et al. 2013), or moving our hand away from a flame.


It highlights that danger detected by sensory nerves from both our environment and our tissue, are sent up the spinal cord to the brain. The brain and spinal cord assess the incoming signals and produce an appropriate output to adapt to remain as safe as possible.


The brain then interprets this information, and determines whether our tissues are in danger or not. If it suspects we are in danger, it produces an output depending on whether we need to protect ourselves or not e.g. movement away from danger, or feel pain in those tissues so that we stop using them.


PAIN


There are three biological mechanisms that can cause an output of pain to be produced:
Nociception (the detection of danger): the exposure of tissues to harmful stimuli occurs. These stimuli can be: chemical, mechanical (overstretch or compression of tissue leading to damage) or thermal (tissue that is too hot or cold) (Smart 2012b).
Central sensitization: a dysfunction within the brain and spinal cord is occuring, so that safe, incoming signals are interpreted as harmful (Smart & Keith 2012)
Peripheral neuropathy: there is damage to the peripheral nerves themselves (all nerves outside of the brain and spinal cord) (Smart 2012a)


It is also important to understand that high stress has also been indicated to increase pain, delays recovery and increases risk of chronic pain development (Lentz et al. 2016).


The next fact is something commonly mistaken.
The amount of pain we feel rarely reflects how much tissue damage there really is (Moseley and Butler 2017).


Think about a paper cut, and how painful this can be. Compare this to cases where people have had their entire leg bitten off by a shark, and have not felt a thing. This is all due to the analysis by the brain and spinal cord of the situation and their believed best response to produce outputs that are most likely to protect the person and give them the best chance of surviving at that given time of detected danger.


Now we will discuss two different types of injury that can occur, both which cause significant pain, yet both which have very different mechanisms of reasons why pain is caused.

BROKEN BONE
Pain reported by a person with a recently broken bone, usually relates well to the extent of the tissue damage and the dominant mechanism responsible for the pain output is nociceptive pain (danger detection through chemical and mechanical changes in the tissue).

MECHANISM – FRACTURE (NOCICEPTIVE PAIN)
Bone tissue breaks due to an inability to withstand the intensity, speed and direction of an applied force. It can be caused by trauma, stress, bone weakness or disease (Westerman & Scammell 2011). Trauma causes sensory nerves to detect a harmful change in shape of tissue, which sends danger signals to the brain and spinal cord. It also causes the release of chemicals that cause inflammation to occur – to kick-start the healing process (Birklein & Schmelz 2008). This sends further danger detector signals to the brain and spinal cord. The brain and spinal cord process the input, identifies threat and outputs pain.

CHRONIC TENDINOPATHY
On the other hand, the degree of pain reported in chronic tendinopathy, does not always relate well to the extent of peripheral tissue damage or pathology, and the dominant biological mechanism responsible for the pain output can be central sensitisation (safe, incoming signals becoming interpreted as harmful by the brain and spinal cord).

MECHANISM – CHRONIC TENDINOPATHY (CENTRAL SENSITISATION PAIN)
Chronic tendinopathy, is an umbrella term for a number of conditions, and refers to a combination of pain and impaired performance of a tendon, which have lasted longer than 3 months (Seitz et al. 2011).
Non-chronic (acute) tendinopathy occurs when there are mechanical changes to the tendon. They are caused by external or internal factors, or a combination of both. Externally, tendon compression occurs, while internally, degeneration occurs (Seitz et al. 2011), both result in inflammation. Therefore both mechanisms produce the detection of harm at the environment and tissues due to chemical and mechanical changes and send this input to the spinal cord and brain, which then outputs pain to the area.

Amazingly, evidence suggests people experiencing chronic tendinopathy can have minimal or no inflammatory cells in the painful tendons. This suggests there is another reason for their brain to produce an output of pain: an altered processing of input within the brain and spinal cord, so that a threat is still detected despite little tissue damage (Littlewood et al. 2013), this can be caused by a range of things, including previous experiences with pain.

For example, if you once had a back injury, and it was painful every time you bent forward, the central nervous system may now associate bending as dangerous and therefore outputs pain to that same area in your back to feel pain before any tissue damage can occur, as a prevention and protection strategy.

Due to the differences in nature of the pain experienced with both conditions, the management strategies for both of these conditions differs substantially.


If you found any of this information useful or intriguing and would like to learn more about your pain and you would like to make an appointment with one of our physiotherapists, contact us.

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How Can I Prevent Back Pain?

How Can I Prevent Back Pain?

How Can I Prevent Back Pain?

The latest research tells us that often people have never had a physical trauma to cause back pain like a car accident, falling, or lifting something heavy. There are usually a combination of factors that cause back pain which could include overuse, poor posture or other stressors.

Keeping in mind everyone is different, here are some expert tips:

Exercise! you can’t escape it, exercise is important for so many reasons, but a big one is preventing back pain. Muscles are meant to move. If you aren’t in good shape, you’re more likely to hurt your back and feel pain when you do even simple movements, such as getting out of the car. Exercise helps keep your joints fluid and your muscles strong.

Core & glute strength a regular strength-training routine that focuses on training your muscles to work together can help support your spine. Core muscles include your pelvis, lower back, hips and abdomen. Strong, activated glute muscles help protect your back from activities such as lifting a heavy object.

Eat well healthy eating habits can keep your weight down. Being overweight can put added strain on all of your joints, especially your spine.

Posture awareness be aware of how often you slouch over your laptop and iphone when texting. Take the time to take a break from long periods in front of the computer with a simple walk around the block or some hip-flexor stretches.

Reduce stress stress can impact your level of pain. Stress causes you to tense your muscles and constant tension can cause back pain. Take up a hobby or regular activity that helps you relax.

Sleep style for most, sleeping on your back can put pressure on your spine, pop a pillow under your knees to reduce this. If you’re a tummy sleeper, put a pillow under your pelvis. Side sleeping is generally the best way to go (but everyone is different!)

Lower back pain can be debilitating and can have a major effect on your daily life and work activities. Don’t let that happen to you, put in place some positive things today.

Physiotherapists are experts in the assessment of musculoskeletal injuries, especially spinal related pain, that’s why we can help you. We can help you with a strengthening home/gym-program for whole-body awareness, strength and posture improvements.

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