Category Archives: Chronic sports injuries

08Jan/14

Too many cases of “I can’t” — the effects of persisting pain

Frequently patients tell me at the first meeting that they cannot do x, y and z. Naturally, when something hurts we avoid that activity or action because pain is unpleasant. It hurts physically and mentally. In the acute stages of an injury or condition, it is wise to be protective as this is a key time for the tissues to heal, and although some movement is important for this process, too much can be disruptive. As time goes on, gradually re-engaging with normal and desirable activities restores day to day living. However, in some cases, in the early stages of pain and injury, the protection in terms of the thinking about the pain and subsequent behaviours becomes such that they persist beyond a useful time. The longer that this continues, the harder it becomes to break the habits.

Don’t feed the brain with “I can’t”, feed it with “I can” — cultivate the natural goal seeking and creative mechanisms of the brain

The vast majority of patients who come to the clinic have had their pain for months or years. I would like to have seen them earlier so as to break the habits of thought and action that are preventing forward movement. As a result of the longevity and severity of the pain, the impact factors, distress and suffering, a blend of experiences, expectations and thinking about the problem, it is common to slip gradually into a range of avoidances that are strongly linked with thoughts that “I can’t do …. or …..”. These thoughts may have been fuelled by messages from care providers.

As a general statement, most activities that someone avoids because they fear that it will be damaging or painful can be approached with specific strategies that address both the thinking about the activity and the actual task itself. Recalling that pain is a protective device, an emergent experience within the body in an area that is perceived to be under threat and requiring defence, by diminishing the threat we can change the pain. And there are many ways of doing this on an individual basis — as pain is an individual experience with unique features for that person.

One of the main aims of our contemporary approach is to ensure that the individual understands their pain and problem so that the fear and threat value dissolves away. This leaves a more confident person willing to engage in training that promotes normal activities and re-engagement with desired pass-times.

10Aug/13

Shoulder injuries: rotator cuff | Our new article in press

Rotator cuff tendinopathy & CNS considerations | our new paper in press here ow.ly/20Tpy3

Authors: Chris Littlewood (@PhysioChris), Peter Malliaras, Marcus Bateman, Richmond Stace, Stephen May, Stephen Walters.

Similar to any injury that persists we must ask ‘why?’ and seek the mechanisms that underpin the on-going experience of pain and altered movement that come hand in hand. One mechanism that has been identified is central sensitisation – see here. In this paper (in press), we consider the role of the central nervous system in rotator cuff injuries, a problem that is often painful and can persist.

Rotator cuff injuries & shoulder pain are common persisting injuries

Chronic injuries require a different approach to treatment and training. As well as improving the health and mobility of the tissues, we must look at the reasons why the body and brain continue to protect the area. Modern pain science has revealed a range of reasons why pain continues including sensorimotor incongruence, central sensitisation, changes in specific cell activity in the brainstem, mechanisms as a result of nerve injury and inflammation, neurogenic inflammation, beliefs about pain, fear of movement and stress to name but a few. These factors are revealed in a detailed assessment with the subsequent creation of a tailored treatment and training programme to tackle the problems at source.

For more details or to book an appointment call 07932 689081

Specialist physiotherapy in London for chronic pain, persisting pain and injuries: clinics in Chelsea | Harley Street | Temple | New Malden