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.
Calf Strength in Running and Walking
Running and Walking are both movements that propel us forward, but did you realise that we use a different amount of energy from our lower limb muscles to perform both of these activities?
These differences in the amount we engage our different muscle groups in our lower limb, depending on whether we go for a run or a walk, are important to understand so that you can target your training effectively.
Why is Calf Strength Important?
What you may find most surprising is that both in walking and running our calves do most of the work in our lower limbs, so calf strength is super important to consider in our training. If you want more power in your strides for either running or, walking then spending some time each week on specifically improving your calf strength will definitely help your movement efficiency.
According to research (Novacheck, 1997) when we go for a walk our calves do 53% of the work, whereas when we go for a run our calves do 41% of the work. This is also why our calves are often sore after a walk or run. This can be especially so if we are new to the exercise or have had a break from walking or running for a while. Post walk or running calf stretches and or foam rolling will also help you keep your flexibility in calves.
At Saanich Physiotherapy and Sports Clinic we recommend that if you are going to start doing strength training, it is best to stretch and foam roll your targeted muscles first . Remember each stretch should be held for at least 30 seconds and foam rolling can done for approximately 1 minute on each leg. Now you are ready to tackle your strength training exercises. If you think about it, trying to contract a muscle that is already super tight it won’t be as effective as you will not have as much available muscle length to work with.
Here are some stats on other important muscles groups:
Lower limb muscle use during walking
Hip Extensors – 7%
Hip Flexors – 30%
Hip Abductors – 6%
Knee – 4%
Lower limb muscle use during running
Hip Extensors – 14%
Hip Flexors 20%
Hip Abductors 3%
Knee – Quads 22%
Treatment Protocols have changed significantly when it comes to sports Injuries even though the injuries themselves have remained unchanged in medical textbooks for many years.
Most of the advances in treatment have come about from research lead by exercise physiologists and specialists who monitor and test our elite athletes and of course lets not forget the sharp learning curve provided by good old fashion trial and error.
It wasn’t that long ago a patient booked for knee surgery would be in a cast and asked to rest as much as possible. Medical specialist began to realise that the cast would accelerate atrophy (muscle wasting) of the leg muscles making postoperative recovery a long and unnecessary drawn out.
Nowadays the complete opposite occurs. Instead of resting and immobilising the injured segment, the patient is given a carefully considered treatment plan combined with prescribed rehabilitation exercises, pre and post-operatively.
There are a number of important factors to be considered before any treatment or rehabilitation program is given to minimise aggravation of the healing structures. A poor and inexperienced approach could set back recovery significantly, or worse, contribute to further damage to the recovering tissues.
Our physiotherapists have years of experience treating injuries. They have seen just about every combination of sports injury and treat many elite athletes.
Treating any injury whether it is sports related, work related or just plain bad luck does not change the rehab rules. Each injury is categorised in different phases with goals and criteria to progress through each different phase.
All our rehabilitation exercises are based on best current practices that are evidence-based. Our Physiotherapists clearly set out what type of exercises are appropriate for the current injury level, how many reps, at what intensity and how many times in the day these exercises should be completed.
Combine this approach with his proven treatment protocols gives our patients the best results.
In nearly all cases, treatment is accompanied by a customised exercise rehab program to accelerate recovery and enhance positive long lasting results.
A Running Analysis at Saanich Physio involves one of our experienced Physiotherapists observing and assessing how you run. We will watch you in real time and also video you, so that we can analyse your form in slow motion.
This kind of analysis is helpful whether you have an injury or if you want to know if you are running with optimal technique. We will explain our findings to you, with analysis of how certain movement patterns or imbalances may contribute to your injury or efficiency as a runner.
We highly recommend this no matter what level of ability you are, whether a beginner, weekend jogger or competitive athlete.
We Are Runners
We feel that in order to understand runners and running injuries, it’s helpful to be a runner yourself. Our Physiotherapists are all keen runners and between them have competed in short and mid distance track events all the way up to half marathons, full marathons and ultra-marathon distances.
We watch you run in real time, then record you and analyse your form using slow motion video. We will outline how your form compares to the ideal. We will only look to change particular elements of your form if it is impacting on your injury, efficiency or if it will help you prevent injury.
We focus on education, with a clear explanation of our findings and how they impact your body. We work with you to achieve a more efficient running technique.
Our aim is to get you back running as quickly as possible if injury is stopping you. We will provide specifically targeted exercises and a return to running program if needed. Our aim is to help you achieve a stronger form, become more efficient, and prevent injury.
Our experienced Saanich Physiotherapists will analyse your running technique and help you achieve better form to prevent injury and maximise efficiency.
Your Physiotherapist will start by discussing your running program and injury history with you.
They will then video you running. From observing you in real time and also through slow motion recording, they will explain what ideal running form is and how your technique compares.
Based on the findings from the video analysis we can give you specific and individualised cues to help improve your form. You will have a chance within the session to practice this on the treadmill and review your video footage.
A biomechanical assessment may also be performed to test your joints and muscles for flexibility and strength. From this information we will create a specific and focused treatment plan that will work to correct your imbalances and help you become a better runner.
Three Steps to Better Form
Video analysis and running assessment software
Biomechanical assessment of your strength and flexibility
Personalised video home exercise program which can be accessed on your smartphone or computer
Patellofemoral joint injury/runner’s knee
Tibialis posterior tendon injury
Iliotibial band syndrome
Hip impingement, labral injuries
Chronic strains and sprains