Using science to treat pain & injury
Pain Education
To deal with the pain effectively you have to understand it. We will explain why it hurts and how pain can persist. The body protects itself in many ways using a range of body systems. This includes the experience of pain to make you attend to the affected area.
Key points
- Pain is an experience produced by the brain in response to an actual or potential threat, modulated by a range of factors
- Pain is not an accurate indicator of tissue damage
- Pain is influenced by stress, emotions, beliefs, fatigue, hormones, general health, past experience, gender & genetics to name but a few
Our emotional state has a huge impact upon the intensity of the pain experience, hence when we are stressed the pain is usually worse. For more on understanding pain click here and here.
As part of the education process we cover the management of flare-ups (when the pain worsens), how to manage day-to-day activities, what to do at work, how to break up tasks (pacing) and the principles of progressive exercise.
Hands-on therapies (manual therapy)
We use physical treatments such as massage and joint mobilisation to improve mobility, reduce the sensitivity, ease tension and guarding (when the muscles become overactive as a protective measure) and to promote normal healthy movement. We combine this with various perceptual and awareness exercises to enhance the effect and incorporate ‘brain training’ (see below) or sometimes just use the techniques as a way of promoting relaxation and calm when the nervous system is very excited or of there is stress at play.
We offer acupuncture (dry needling) as a mode of pain relief.
Specific Exercises
When we look at the way that you move (how far, how confident, how controlled) and posture the body, we can see where training is required. Some areas may need mobilising or stretching, other areas may need to gain better control or to develop strength. In order to control movement normally the brain must receive accurate information from the tissues about what is happening (normal sensation). When we have had pain or an injury for some time, this process is altered and the brain does not receive all the information that it requires. This usually manifests as poor control of movement and poor position sense (proprioception) and requires re-training. One of the common reasons for recurring problems is that the controlling mechanisms have not been fully restored. Often it is assumed that when the pain is better, all is well. Normal movement must be restored along with a normal sense of the area. We use some specific tests for both of these aspects.
Guarding is a protective measure that we control consciously at times when we feel threatened, however the brain also guards when it is planning movement of an area it perceives to be in need of protection. In many cases we are not aware of this aspect but it is observable and something we look for as it requires retraining. This retraining comes from gradual exposure to the affected movements alongside effective coping measures and understanding, both of which reduce the threat value to the brain (remember that pain and guarding are protective measure implemented by the brain and hence why we must target these processes for successful treatment).
Fear of movement is a common problem that needs specific training to overcome.
Training is hard work that needs time, focus, concentration, motivation, effort, persistence & consistency – master normal healthy movement: Mastery 1 & Mastery 2
Modern neuroscience based therapies
A range of techniques and therapies are used to target changes that occur in the brain, nervous system and other body systems. These are very modern techniques that are based on the latest understanding of pain and the brain. Pain is a brain experience and therefore we must target the processes ‘up top’ that change in their workings and how they appear. Treat the brain to treat the pain.
We know that the brain changes and that the representation of the body in the brain changes when we have had pain and injury for a while. There are representations (maps) in various parts of the brain including the sensory cortex and motor cortex. It is with these maps that the brain controls movement and knows what the body is doing. The maps are genetically defined but moulded with experience (e.g. learn the violin and increase the finger representation). ‘Use it or lose it’ is a phrase that describes the changes as we can really develop aspects of the maps but we can also diminish or ‘smudge’ the maps with a lack of use, i.e. though pain and/or altered movement. Another useful phrase is ‘nerves that fire together wire together’, hence the principle of practice to improve the efficiency of how the nerves communicate. This of course also means we can ‘practice’ altered movement patterns and groove efficient neural pathways in the brain to give on-going experiences including pain and body responses to stress and negative thoughts.
Modern rehabilitation incorporating neuroscience principles means that in part we are targeting these processes to give you a good experience in terms of reduced pain and a greater ability to move, perform work and sports.
Under this banner is the Graded Motor Imagery Programme that is ‘brain training’ to improve both pain and function. This is used for CRPS and other persisting pain states. We use these techniques commonly at the clinics and teach you how to do it at home as part of the self-care and active approach to rehabilitation.
The immune system is hugely involved in on-going pain and injury and part of our programming looks at neuroimmune responses that are creating your experience of pain. These can be triggered by movements, exercises and daily activities but also by stress, fear of movement, negative thinking, visual input (e.g. seeing someone else move) and other stimuli that your brain deems ‘threatening’. We use techniques that tackle these responses by setting up the right environment, context and understanding for you to do the necessary training both in the clinic and in your home and workplace.
General Exercise
We will provide you with advice on exercising for general health benefits, stress relief and to promote a healthy lifestyle. Often this is limited due to the pain so we work progressively to build up tolerance and participation levels. Exercise and movement can be analgesic, so we look at working other body areas in order to feel a general sense of relief.
Self-care strategies
This includes how to manage posture including developing increased awareness so that you can make the relevant changes, pacing activities, how to manage activities and time at work, relaxation, strategies to deal with negative thinking that can influence the pain, mindful techniques for pain and stress and other ways to positively affect your experience. As well as doing the specific exercises, it is fundamental to the success of the programme that you are managing the rest of the time (the bulk!) effectively. The strategies are simple in essence but often involve habit change and this is the challenge to master. In persisting, persevering and being consistent you are creating the right environment for a change that will be positive.
MOTION IS LOTION
Mindfulness
Mindfulness has been around for a long time and in terms of pain, stress and anxiety has great benefits. The NICE guidelines recommend the use of mindfulness of depression. There has been significant research done both in terms of the effects and the underpinning activity in the brain. In essence one can develop a sense of calm, objectiveness towards the pain and hence control, clarity and diminishing impact of the pain upon oneself. Worth looking at are Jon Kabat Zinn’s book (click here) and the Breathworks website.
Disclaimer
The resources on this site should not be used as a substitute for professional medical care or advice. Users seeking information about pain should consult with a qualified healthcare professional.
